Telemedicine can improve access to quality, affordable care in Texas (Texas Tribune)

TEXAS TRIBUNE | If you become ill and need a doctor tonight at 11, who will you call? What will you do?

Texans in Austin, Dallas, or Houston are probably surprised to learn that Texas ranks 47th in the nation in the number of active primary care physicians per capita. Among its 254 counties, 35 have no practicing physician, and 80 have five or fewer, according to research conducted in 2015 by Merritt Hawkins. And 185 counties — more than 70 percent — lack a psychiatrist. The doctor shortage is an issue that impacts most of the state.

In recent meetings with state legislators and other public officials, I have emphasized the importance of making telemedicine a priority in the current legislative session.

Read more at TribTalk.

Less salt in foods means longer lives — Trump’s administration can fix this (The Hill)

THE HILL | No state is an island when it comes to our food and its impact — good or bad — on our population’s health.

That’s why it’s critically important for the Food and Drug Administration (FDA) to continue its efforts to reduce sodium in our packaged and restaurant foods. In June, the FDA published a draft voluntary guidance to the food industry, establishing targets for sodium reduction in two years and in 10 years. It’s time to finalize that guidance.

Read more at The Hill.

Supporting Betsy DeVos for Secretary of Education

Betsy DeVos has been nominated for the next U.S. Secretary of Education, and I believe she is the best person for the position. I’ve known Betsy for many years, and I’ve seen firsthand her passion for education and for our children. Here is the letter I’ve just sent Lamar Alexander, Chairman of the Committee on Health, Education, Labor and Pensions in support of her confirmation. 

 

Dear Chairman Alexander:

In advance of Mrs. DeVos’s  January 17th confirmation hearing in your committee, I share my strong support for her confirmation as our next U.S. Secretary of Education.

Young people in America today are entering a workforce that is the most competitive we have seen in our lifetime.  Our economy is truly global, and how well our students are learning is being measured on an international scale.

We also know that, in too many communities across our country, students are receiving an education that is leaving them unprepared for next steps after high school—a reality that has a deep impact on the success and future of our citizens.

I devoted much of my post-U.S. Senate career to improving public education in Tennessee in an effort to jumpstart long-term educational change in our state and ensure that every child graduates high school prepared for college or a career.  As a surgeon, I also know that education impacts all aspects of our life, including health.  Studies I led for the Robert Wood Johnson Foundation found that education is one of the best predictors of health outcomes from life expectancy to the infant mortality rate.

It is for these reasons that I am both excited and hopeful about the nomination of Betsy DeVos as the next U.S. secretary of education.  I have known Mrs. DeVos for many years, and I know firsthand that her passion for education comes from a deep desire to do what’s best for our nation’s children.

In Tennessee, we have shown what is possible in improving public education.  Tennessee has gone from 46th in the nation to 25th in 4th grade math in just four years. We now rank 19th in the country in 4th grade science.  More Tennessee students are enrolling in and completing education beyond high school—education that will help them secure a bright future for themselves and their children.

This progress has been made due to the reforms Tennessee has committed to—stronger teacher evaluations, higher expectations for students, teacher tenure reform, and expanding high-quality school choices for parents, among others—and those reforms must continue in order to ensure success for all students.  As the center of gravity in education moves away from the federal government and into locals’ hands, we need a secretary of education who can both safeguard the flexibility states need to advance these reforms and inspire innovation that will challenge the status quo.  I believe Betsy DeVos is that leader.

She has more than 28 years of experience advocating for policies that are good for students, policies like more choices for parents, ensuring high-quality teachers in the classroom, and protecting the right for every child to receive an excellent publicly-funded education.  With a devotion to transforming our K-12 education system that has received wide-ranging bipartisan support at the local and national levels, Mrs. DeVos fits the bill for the trailblazer needed at the helm of federal education policy.

Most importantly, she puts children at the forefront of her advocacy efforts. As a mother and grandmother who, together with her husband, helped start a high-performing public charter school in Michigan, Mrs. DeVos is intimately familiar with education policy from all angles. In fact, West Michigan Aviation Academy is the top-rated public charter high school in the state of Michigan.

Betsy DeVos will bring a renewed sense of urgency and focus to improving schools in neighborhoods across America.  As someone who has worked with Mrs. DeVos for years, I urge the U.S. Senate to confirm her nomination.  She is the public servant our country needs leading the U.S. Department of Education.

Sincerely,

William H. Frist, MD

Groundbreaking 21st Century Cures Act

The US Senate just voted 94-5 to pass the 21st Century Cures Act. This is an historic moment for American medical innovation and the millions of patients who will benefit.

The Cures Act is groundbreaking. Over the 40 years I have been in medicine, there has never been a more exciting time for medical innovation than today. The Senate’s passage of this bill will impact millions of Americans and give a big voice to patients in improving their care. With an estimated 7,000–10,000 known molecular-based diseases without cures, we now have an opportunity to change that trajectory and find new cures and treatments for patients.

Chairman Lamar Alexander’s vision and steady leadership in spearheading the Senate version through the Health, Education, Labor and Pension Committee was vital to making today possible.  I worked with Senator Alexander and the Bipartisan Policy Center to bring in medical perspectives from across the county to develop key pieces of the final legislation, including language to advance regenerative cell therapies that hold promise for restoring vision, repairing hearts, and rebuilding damaged joints.

This legislation includes major investments in cancer research, precision medicine, opioid-abuse prevention, and neurological disorders, paired with the streamlining of regulations, that will advance treatments for the millions of Americans still suffering from untreatable illnesses.  No other legislation enacted this Congress will do as much good for so many.  Its passage today will pave the way for groundbreaking cures that will touch nearly every American family, and demonstrates that Washington can still work together to address the most pressing needs of the American public.

For more information, please see the press release from the Bipartisan Policy Center:

FOR IMMEDIATE RELEASE

December 7, 2016

Contact: Joann Donnellan
(703) 966-1990
jdonnellan@bipartisanpolicy.org

Congress Puts Patients First Passing Groundbreaking 21st Century Cures Act

Washington, D.C.– Today, Congress put patients first by passing the 21st Century Cures Act – groundbreaking medical innovation and research legislation that will help millions of Americans with life-threatening diseases and their families. The Bipartisan Policy Center applauds Congress for working together to achieve this rare bipartisan compromise. It signals an encouraging moment for the nation that their government can make progress on behalf of the American people.

“The Cures Act is groundbreaking. Over the 40 years I have been in medicine, there has never been a more exciting time for medical innovation than today,” said former Senate Majority Leader Bill Frist. “The Senate’s passage of this bill will impact millions of Americans and give a big voice to patients in improving their care. With an estimated 7,000–10,000 known molecular-based diseases without cures, we now have an opportunity to change that trajectory and find new cures and treatments for patients.”

“I congratulate my former colleagues on tackling this ambitious legislation and succeeding,” said former Rep. Bart Gordon. “It shows the American people that Congress can work together to create and pass meaningful legislation that will touch their lives. I am especially pleased to see the Senate honor Vice President Biden by renaming the cancer moonshot and NIH innovation projects in the bill for his son Beau, who lost his brave battle to cancer last year.”

BPC began its medical innovation initiative in 2014 under the leadership of former Senate Majority Leader Bill Frist, M.D., and former Rep. Bart Gordon. The Cures bill reflects many provisions outlined in its July 2015 report Advancing Medical Innovation for a Healthier America: bringing the voice of the patient into the drug development process, increasing the use of real-world evidence and drug development tools to improve the drug development process, advancing precision medicine to tailor treatments for patients, enhancing the FDA’s ability to hire and retain top scientific talent, improving interoperability and increasing regulatory clarity associated with health information technology, and improving the regulation of regenerative cell therapies.

“This legislation will accelerate the development of promising new treatments and cures for Alzheimer’s disease, Parkinson’s, heart disease, diabetes, and cancer,” said Janet Marchibroda, director of BPC Health Innovation. “Extending the existing FDA accelerated pathway to include regenerative cell therapy will preserve the gold standard for safety and efficacy. This is not only groundbreaking for patients, this is groundbreaking for their families and caretakers who can also be affected.”

“Ultimately, this legislation will accelerate the discovery, development and delivery of new drugs and devices in a safe and effective manner and modernize the Food and Drug Administration,” said former FDA Commissioner Andrew von Eschenbach, who serves on BPC’s medical innovation initiative advisory committee. “It will also empower the FDA to significantly enhance the scientific resources it requires to cope with the advances in the science and technologies of medical product development.”

The bill supports significant investment in innovation and research at the National Institutes of Health and the Food and Drug Administration, including President Obama’s precision medicine initiative so doctor’s can tailor treatments to patients; the Beau Biden Cancer Moonshot to fight cancer; the BRAIN initiative to find new cures and treatments for neurological disorders and brain diseases, and to address mental illness and opioid abuse.

How NashvilleHealth Is Maximizing Community Population Health (Health Affairs)

HEALTH AFFAIRS | How can Main Street, America, move the needle in a city’s population health and wellbeing? It begins with a solid, organizational structure built for the long term.

I fondly call my hometown, Nashville, the “Silicon Valley of Health Services.” With 18 publicly traded national health care companies headquartered here with annual global health care revenues of over $70 billion, our city takes health seriously. One in 10 workers in the Nashville metro area are health care providers, nurses, or health aides. Even more work in the broader health sector, such as health management, financial, and legal roles. We have two outstanding medical schools, six schools of nursing, a dental school, and two schools of pharmacy. Our city is in the business of providing multiple health services to every state in the country.

Here is the cruel irony. When you compare us to similar cities, the health of Nashvillians is poor. We smoke at rates higher than Charlotte. We have blood pressure rates that exceed those in Austin. Our obesity rate surpasses Cincinnati’s. Our infant mortality rates are not even competitive. Our babies are more likely to die in their first year of life than in countries like Croatia, Serbia, and Qatar.

How can that possibly be? One of the things they didn’t teach me in medical school is that health services delivered accounts for only 10 to 15 percent of a population’s health status. We can build the best hospitals, provide the richest health plans, and I can be the best heart surgeon possible, but behavior and how and where people live, eat, work, and play have a far greater impact on an individual’s health.

Read more at Health Affairs.

TrumpCare: In The Beginning… (Forbes)

FORBES | The immediate question for those whose lives focus around lifting the health of individual Americans is, “What does Donald J. Trump’s presidency mean for health care in America?” At the heart of the answer is uncertainty. Trump is an “unknown unknown” when it comes to deep, thoughtful health policy. He has excelled in many fields, but at best he personally has only dabbled in the field of health care, which accounts for a fifth of our overall economy and affects literally every American. So, to begin to answer the question, we can only start with what he has said on the campaign trail and the bare-boned, seven-point “plan” on his website and conjecture from there.

Read more at Forbes.

It’s time for the U.S. to lead on combating global malnutrition (The Hill)

THE HILL | One single public health crisis accounts for nearly half (45%) of all child deaths under age five. Every 4 seconds, a person dies from this cause – approximately 21,000 every day. And shockingly, nearly one in nine people globally is affected.  What is this epidemic that has taken so many lives? That has wreaked havoc on so many families? It’s want of a most basic need: we still have 795 million people worldwide who suffer from various forms of malnutrition and undernourishment.

This is not a complex disease where we need to develop new treatments, build new clinics and health infrastructure, or educate patients on prevention and medication adherence. But it is a health challenge that requires bold leadership and the commitment of greater resources from developing and developed countries. The United States should lead the way, and our next President has a unique opportunity to mobilize the global community around this critical issue.

Read more at The Hill.

Tennessee Makes Huge Strides

In 2013, Tennessee’s progress on math and reading scores was considered a bright spot. Today, our students continue to excel and have made Tennessee the fastest improving state in science since 2009.

On behalf of our team at SCORE (State Collaborative on Reforming Education), I applaud our students and teachers for their tireless efforts to strive for better. Building on our record improvement in math and reading scores in 2013, there is no doubt in mind that the future of our Tennessee children is bright.

This morning, the 2015 National Assessment of Educational Progress (NAEP), known as the Nation’s Report Card, released its 2015 Science Assessment Results, and the Volunteer State has a reason to be proud.  Tennessee is the only state to grow faster than the nation in both fourth and eighth grades, with Tennessee students doubling the average national growth in science. Our state has moved into the top 25 in science — the highest ranking it has ever held — and is now 19th and 21st in the country for fourth and eighth grade. Data demonstrated that our gender gap was eliminated, and achievement gaps between white, African-American, and Latino students narrowed.

At SCORE, we have seen firsthand the long hours and hard work put in by our teachers, school and district leaders, parents, and especially our students to make today’s exciting achievement a reality.  SCORE’s focus on driving statewide collaboration on policy and practice to ensure student success is paying off.

“Since the state began raising expectations, strengthening teaching, and emphasizing post-secondary education and workforce readiness for all students, Tennessee academic growth has been fast and sustained in multiple subjects over multiple years,” SCORE CEO Jamie Woodson said. “Although proficiency levels are not yet as high as we know our students are capable of achieving, Tennessee’s trend is decidedly in the right direction.”

SCORE will continue to work hand-in-hand with our state’s education leaders, teachers, and students to sustain and build on this headline-worthy progress.

The Last Shall Be First: Haitian Women Taking Steps To End Poverty (Forbes)

FORBES | How is it possible that the people of the poorest country in the Western Hemisphere have to shoulder repeatedly the impact of one natural disaster after another?

And what can we do as one of its closest neighbors – and by far the wealthiest country in the hemisphere – to best empower the people of Haiti to respond and to rebuild and indeed eventually to prosper after disaster strikes?

These are the questions we ask today as we see a people struggling to recover from a devastating hurricane earlier this month and an ominous rise in cholera outbreaks.

These are also the questions that a delegation of faith-based influencers from Hope Through Healing Hands and CARE asked last month as we visited Haiti to see what’s working and what’s not in terms of social and economic progress since the destructive 7.0 magnitude earthquake in 2010.

Read more at Forbes.

Hurricane Matthew & Haiti A Week Later

Hurricane Matthew, a category 4 storm, made landfall at about 7am this morning on the southwestern tip of Haiti.  Tracy and I just left Haiti a week ago, where we traveled with Hope Through Healing Hands and CARE to assess progress made since the massive 7.0 magnitude earthquake that struck in January 2010, resulting in 300,000 deaths and 1.5 million displaced people.

The full impact of Hurricane Matthew is not yet known, as the storm continues to linger over the island nation.  However, reports indicate communities under water, buildings stripped of roofs, and homes damaged or destroyed.  At least one citizen is dead and others are missing, although no formal figures have been released yet on the toll taken on human lives.

Haiti is the poorest nation in the Western Hemisphere, and much of its population still lives in shanty towns and tents following the earthquake.  Some Haitians were hesitant to evacuate for fear of leaving their homes and having their only possessions stolen.

Rapid emergency response following a disaster of this magnitude is vital to saving human lives, preventing spread of disease, and mitigating damage to infrastructure.  Hope Through Healing Hands is taking action to provide emergency relief and support again for our Haitian friends in Port au Prince and surrounding areas. You can help by donating to the HTHH Hurricane Matthew emergency relief fund here.  The funding we raise will be distributed, as we did after the earthquake, with trusted beneficiaries whom we know allocating directly for various relief efforts.

Our thoughts and prayers are with the Haitian people today.

The Newborn Illness That Nobody Is Talking About – And It’s Not Zika (Forbes)

FORBES | Nothing can prepare a mother for seeing her newborn seize multiple times an hour, refuse to eat or sleep, and shake uncontrollably. That’s what Julia found herself facing after severe chronic back pain from a car accident left her dependent on opioids. Julia had been a college student from a middle class family with a bright future, and never imagined she would end up an addict with a newborn diagnosed with Neonatal Abstinence Syndrome (NAS).

Read more at Forbes.

Back to Haiti

NOTES FROM THE ROAD | It’s no secret that I believe investing in global health is absolutely essential, and investments in women and girls—particularly maternal and child health—does nothing less than change a country’s trajectory.

Next week, Tracy is joining me as I lead a delegation from all over the United States on a learning tour to Haiti to see firsthand the changes being made in the lives of women and how those changes are building communities.

This will be my fourth trip to the country. I first visited immediately after the earthquake in 2010. Two days after the 7.0 magnitude quake hit right outside Port au Prince, I joined Samaritan’s Purse on a medical mission. At the same time, Hope Through Healing Hands—our global health nonprofit led by Executive Director Jenny Eaton Dyer PhD—launched the Haiti Disaster Relief Fund to provide medical services, equipment, and support for those who needed immediate clinical attention. We raised over $160,000 which was donated in full to trusted beneficiaries already on the ground.

frist

In the six and a half years since the earthquake, Hope Through Healing Hands has stayed vitally connected to Haiti. I was part of the founding board of the Clinton-Bush Haiti fund that raised over $60 million to help facilitate the long-term rebuilding and healing in the country. Hope Through Healing Hands has been sending midwives and nurses to serve in the country through our Frist Global Health Leaders program. Just last year Laurent Lamothe, the former Prime Minister of Haiti, joined me in Nashville to share a bit about Haiti’s future.

But next week our traveling group will see firsthand some of the things Hope Through Healing Hands has been sharing for the past several years.

In Haiti, we’ll be meeting with non-governmental organizations (NGOs), faith leaders, and the U.S. Mission. We’ll visit groups with longstanding efforts on the ground in Haiti including World Relief. We will meet with women and girls and hear from them how healthcare can break the cycle of poverty, and how education builds communities. We’ll tour a rural health clinic, a maternity ward, and a regional hospital.

Haiti has the highest maternal and child mortality rates in the Western Hemisphere. Just imagine how addressing those problems will strengthen families, stabilize communities, and support the entire nation.

We are particularly excited to be partnering with CARE on this trip. CARE has been actively fighting poverty in Haiti for more than 50 years, investing in programs of economic and food security for women and youth, sexual and reproductive health, and education.

I’m looking forward to sharing what we learn. It promises to be an eye-opening week.

(If you want to check out some videos from my very first trip, it’ll be amazing to compare how far the country has come!)

Thank you and best wishes to Risa Lavizzo-Mourey

Earlier today Risa Lavizzo-Mourey, MD, MBA, the first woman and the first African American to lead the Robert Wood Johnson Foundation (RWJF), announced that she was stepping down from her role as President and CEO of the Robert Wood Johnson Foundation.

I have been honored to serve with Risa on the RWJF Board. Her leadership is unparalleled: visionary and strategic, but with compassion and strong conviction. Risa is the origin of the “Culture of Health” movement that is sweeping the country now and will continue for years to come. She has put a face on the public health needs of the most vulnerable in this country, and made clear the essential role the private sector plays in building healthier, more equitable communities.

As an outspoken advocate of looking at health not just as healthcare, but as the conditions in which people are born, grow, live, work and play, Risa and RWJF are transforming our nation’s approach to wellness. Her work as CEO of the Robert Wood Johnson Foundation has personally touched thousands and will impact millions. She will be sorely missed, but her legacy will live on in the countless life-changing initiatives she has cultivated at the Foundation.

I wish her all the best.

Risa’s inspiring good-bye letter and charge for the future.
Robert Wood Johnson Foundation press release

Congress Must Preserve Quitlines and The Tips Program (Forbes)

FORBES | Smoking is the number one killer and public health challenge today, causing more deaths each year than automobile accidents, firearm-related injuries, HIV, illegal drug use, and alcohol abuse—combined. As a surgeon, it was the primary cause of the heart and lung disease that I operated on every day for 15 years.

In my home town of Nashville, Tennessee, approximately 110,000 people smoke—21% of the adult population. Each is cutting on average seven to ten years from their lifespan. Their habit is costing them years lost from family, friends, and loved ones. I take this issue seriously, and we recently launched a broadly supported, collective impact initiative called NashvilleHealth, which is rallying the community to address smoking as the number one health challenge to the vitality of our county.

Read more at Forbes: http://www.forbes.com/sites/billfrist/2016/09/09/congress-must-preserve-program-that-has-helped-nearly-a-half-million-americans-quit-smoking/#72fd6c785841

How Bundled Payments Can Change Healthcare (The Hill)

THE HILL | Rising health care costs are a top concern for Americans today, with 64% of voters in a January 2016 Kaiser Health tracking poll, citing a candidate’s position on the cost of health care, health insurance, and prescription drugs as “the single most important factor” or “a very important factor” in their vote for president.  With health care costs continuing to outstrip inflation, not surprisingly, many Americans are looking to curb their out-of-pocket health care spending. Tom Daschle and I believe that now is the time to find and implement innovative approaches to fundamentally transform our approach to health care. Bundled payments should play a critical role in that.

Read more at The Hill: http://thehill.com/blogs/congress-blog/healthcare/291918-moving-the-needle-on-health-care-transformation

FDA Draft Guidance on Real-World Data (Forbes)

FORBES | In a document issued this week, the Food & Drug Administration laid out for comment its draft guidance of how real-world evidence could support regulatory decision-making for medical devices. This is a positive step forward for improving the medical product development process. At the Bipartisan Policy Center, Representative Bart Gordon and I have been urging FDA to advance medical innovation with real-world evidence. FDA has limited this guidance to how real-world evidence may be used for regulatory review of medical devices. But the FDA is to be applauded for taking this step, and acknowledging the increasingly vital role real-world data (RWD) will have in healthcare.

Read more at Forbes.

Exploring the Social Determinants of Public Health with Robert Wood Johnson Foundation

NOTES FROM THE ROAD | Scotland—Survival of men and women in Scotland is the worst in Western Europe. So is their general health. Why is that? What is being done? How successful are the new, bold initiatives that were launched in 2010?

I am in Glasgow with the board of the Robert Wood Johnson Foundation (RWJF) to explore these fundamental questions to better inform us to shape what we can do in Nashville though our bold new, community wide initiative NashvilleHealth to improve our current poor population health at home.

Scotland’s ongoing commitment since 2010 to make Scotland the best place in the world to raise a child, with the long-term goal of improving the social and health outcomes over the course of a generation, is similar to our efforts at NashvilleHealth.

And Scotland shares many of the same political, economic, and demographic profiles as the US, and Nashville.

Glasgow is about the size of Nashville: home to 600,000 people, with another 600,000 in the surrounding metropolitan area. Nashville has worse health than similar cities like Charlotte, Austin, and Denver; Glasgow has worse health compared to other UK cities with similar characteristics, such as Liverpool and Manchester. Smoking rates are about 23% for both cities. And like Nashville, within the Glasgow metropolitan area, there are even greater disparities.

In both Nashville and Glasgow, explanations for these disparate health outcomes include inequities in income and educational attainment but also social isolation, excessive tobacco and other substance abuse, unhealthy diet, and high rates of adverse childhood experiences.

A starting point for my investigations in Glasgow is similar to what we as a community are doing through NashvilleHealth at home: examine how various sectors are working together to improve the outcomes of existing programs that are aimed at helping families and children in health need.

IMG_6692 IMG_6689

 

When Regenerative Medicine Changes Everything (Forbes)

FORBES | Two weeks ago I led a panel discussion at the Bipartisan Policy Center (BPC) on medical innovation with my good friends Senator Lamar Alexander (R-TN), who chairs the Senate Health,Education, Labor and Pension (HELP) Committee, and former Congressman Bart Gordon (D-TN), who previously chaired the House Committee on Science and Technology.  We were joined by Nashville native Doug Oliver, who had a powerful story to share.

Senator Lamar Alexander (R-TN), Doug Oliver, former Congressman Bart Gordon (D-TN), and myself.

Senator Lamar Alexander (R-TN), Doug Oliver, former Congressman Bart Gordon (D-TN), and myself.

Doug inherited a rare condition called dry macular degeneration. His vision began rapidly deteriorating at age 32, and within a year he was legally blind–unable to recognize faces, read the paper, continue his IT job, or drive a car. His doctor told him told him there was no cure but encouraged him to monitor clinicaltrials.gov, the federal site we set up when I was in the Senate where NIH-approved clinical trials are listed, for any new experimental studies that specialized in his illness.  Doug was diligent and in time found a physician in Florida who was treating his condition with patients’ own stem cells.

Doug’s decision to participate in this clinical trial was life-changing. His own stem cells were isolated in a centrifuge from bone marrow drawn from his hip bone, and then injected into his retinas. Doug saw improvement overnight, and within months—after a decade of blindness—he passed the Tennessee driver’s test and got his license back.

Read more at Forbes.

How Real-World Data Could Change Medicine (US News & World Report)

US NEWS & WORLD REPORT | With continuing advances in science and technology, the pace of medical breakthroughs is accelerating. Today, we can treat or even cure conditions that significantly shortened life just a generation ago. The exciting promises of personalized medicine are now becoming reality.

Congressman Bart Gordon and I co-chair the Bipartisan Policy Center’s initiative on Advancing Medical Innovation, and we believe that real-world data – data already amassed in electronic health records and other clinical software, claims systems and even in patients’ personal health tracking devices – is a rich source of information that can play a key role in accelerating the Food and Drug Administration’s approval process for promising drugs and devices to patients in need.

Read more at US News & World Report.

Better Healthcare at Lower Costs (AHIP 2016)

NOTES FROM THE ROAD | I had the privilege of speaking yesterday at America’s Health Insurance Plans Institute and Expo. Along with Bernard Tyson (Kaiser Permanente) and David Bernd (Sentara Healthcare), I discussed “Better Health Care at Lower Cost: Is It Possible?”

You know my answer: It is absolutely possible with technology. In case you weren’t able to join us, here’s my view of where we are, and where we can go.

 

I am a surgeon. I like to cut, and sew, and fix. I like to keep things simple. So my central organizing thesis is this: Health care delivery today fails because of a massive mis-allocation of resources toward the goal of a patient’s health. We overuse, underuse, and misuse existing resources.

We overuse health services, driven in part by a fee-for-service payment model.

We underuse prevention services and techniques.

We misuse our existing resources—doctors, facilities, medicines— by neglecting evidence-based medicine.

This can be fixed. These are exciting times; we will see more innovation in health service delivery in the next three years than we have in all the history of modern health care delivery.

Let me give two examples, and then toss out a challenge.

Aspire & A Better Way to Die

First, in America people don’t die the way they want to. They too often die chaotically and uncomfortably, with huge costs to the patient and the system. There are too many hospitalizations, too many trips at 2 AM to the emergency room, too many painful side effects from medicines, too much discomfort.

But it doesn’t have to be that way.

A company named Aspire Health is showing us the way.

Two years ago, a group of us founded the palliative care company Aspire Health to strike right at the heart of this end-of-life chaos and waste.

Aspire took the successful, decade-old model of inpatient, brick-and-mortar palliative care and modernized and transformed it using IT and specialized teams, moving it exclusively to the outpatient and post-acute space.

Aspire is pioneering the way, taking this new model to national scale, now in 13 states and 36 cities working with 14 insurers, including many of you in the room.

It has definitively given better results for much less cost. How?

  1. It focuses on not just physical care, but on emotional, on spiritual, and on mental health as well.
  2. It focuses on not just the patient, but the family and caregivers.
  3. It delivers care not just with any doctor, but a specially-trained, palliative care doctor and a tightly-knit team of a palliative-trained nurse practitioner, social worker, registered nurse and chaplain.

It’s highly specialized care—highly individualized for the patient at the end of life—and delivered in the home with intense attention to social determinants and environment.

What’s the secret sauce?

Analytics: Early, up-front and highly accurate identification of those specific patients who definitely will benefit. Everyone claims to have these algorithms and analytics, but they don’t. Aspire’s model is proven to work.

Specialists: Aspire’s care team features specially-trained palliative physicians and nurses. These are experts on end-of-life medicine. They know how to talk and treat, understand and empathize, with these specific patients and families.

Access: Aspire patients have 24/7 access to a physician or nurse practitioner. Patients and their families always have someone to call in a crisis. They don’t have to go to the emergency room.

Technology: The system is built on powerful IT-managed caregiver workflows, which ensure that the patient always has the right person, at the right place, at the right time.

The outcomes speak for themselves. For 12,000 end-of-life patients we found:

  • Higher satisfaction for both patient and family
  • Fewer hospitalizations (60% reduction), but more patient contacts in smarter settings (home)
  • Earlier referral to hospice (31 days vs 13 days) with continuity and communication ensured
  • Savings of $13,000 per patient served (from a study with two years data across five states with matched cohort comparison)

Better health at lower cost is possible as long as we use existing resources smartly.

Teladoc & Telemedicine

Today, narrow networks rule the day. Wait times for primary doctors continue to rise.

Emergency visits are going up with expanded coverage. And rural hospitals are closing.

But today’s technology can radically improve convenient and timely access to expert physicians. Telehealth is one of the few solutions that increases the capacity of the system by improving access to care while driving down costs.

There are a small handful of companies emerging in this space. Teladoc is by far the largest telemedicine company in the country.

It will approach one million doctor-patient visits over the next 12 months. A million individuals all of whom who would otherwise have had diagnosis and care delayed, and may have ended up in emergency rooms without a telemedicine option.

Imagine for a moment, it’s 10:30 at night and your child is suffering from a high fever or some other nonemergency illness. You either anxiously wait until the next morning to try to track down a doctor (good luck), or more likely you get in a car, drive 45 minutes to the emergency room, wait an hour, see a nurse or doctor in or out of network, and drive back home 5 hours later ending up with a $1400 bill from the hospital!

Or… within 10 minutes you reach a board certified doctor by phone or video, licensed in your state, who has an average of 8 years of clinical experience. At a cost of $45 out of pocket.

Yes, a full 50% of the more than 1.5 million doctor visits Teladoc has had to date occur on nights, weekends, and holidays, when doctors’ offices are closed, and the ER or Urgent Care Center is the only alternative.

Technology-enabled, remotely-delivered care provides equal outcomes delivered much more quickly and conveniently, yet at much much lower price. The purpose is not to replace the primary care doctor but to fill the gaping holes—to improve access and deliver quality care when and where it is needed for a fraction of the cost.

Every payer and system in this room will grow its reliance on telemedicine. Willis Towers Watson says that within a year and a half, over 80% of large employers will offer a telemedicine benefit.

How do you decide whom to partner with?

First, you must insist upon quality measures. Telemedicine has a low barrier of entry—it can get dumbed down quickly by inferior doctors—but a high barrier to scale.

Second, look for high patient engagement. Telehealth is an empty promise without active patient engagement. Without engagement and use by the patient, the value, and cost savings, will never be realized.

With the value of telemedicine so obvious, what has been the biggest barrier to more widespread adoption? To date it has been the resistance of some state medical societies who hold on to antiquated models of practice delivery. This is rapidly changing as quality and cost data so powerfully demonstrate the effectiveness and safety of remotely delivered, evidence-based medicine.

The Challenge

Imagine yourself in my 12th floor conference room in Nashville across from the park three days ago. 15 people are gathered around the table including the CEOs of the five largest employers in Nashville, the four largest health care companies—big public companies like HCA, Emdeon, Change—and representatives from the more than 120 nonprofits and churches in Nashville who have some interest in improving health.

It was the inaugural board meeting of NashvilleHealth, a new, county-wide collaborative that has come together to do a simple thing: Take the aggregate population health measures of Nashville, as reported by the Robert Wood Johnson Foundation—which are poor—and make them the best in the state. And then outperform our peer cities of Charlotte, Austin, Raleigh-Durham, and Cincinnati, all of whom are beating us badly now.

Our goal is to create a culture of health, to make the healthy choice the easy choice, and to focus on the social determinants of where and how we learn, live, work, play and pray.

Our discussion centered on a real example of how we REALLY improve health. Smoking rates in Tennessee are 23%, which means we have 110,000 smokers in Nashville. If we take that down to the national average of 15% or 70,000, that means we have 40,000 fewer smokers within 5 years. We have the knowledge and the proven tools today to do that. We didn’t five years ago.

40,000 fewer smokers translates conservatively into 200,000 years of life saved. Not across the country, or across the state, but within a 3 mile radius of where we were sitting in my conference room.

That reduces the burden of disease.

That conserves the health care dollar.

That improves wellbeing and productivity.

That saves lives.

So I close with a call to action. To maximally reduce cost and improve well-being, you lead the way in your home town of formalizing your own NashvilleHealth. It’s where the real cost savings and health determinants can be achieved.

Salty Stuff (The Hill)

THE HILL | When more than 75% of the sodium you eat comes from processed foods and restaurant meals, it can seem like the problem is out of your hands. How can you cut back on salt effectively when you can’t control those foods? The Food & Drug Administration feels the same way. In a draft guidance issued yesterday morning, FDA called for the processed food, restaurant and food service industries to reduce sodium in their products. It was a wise recommendation, and not a moment too soon.

Read the rest at The Hill.

The Most Helpful Illegal Medical Procedure (Fox News)

FOX NEWS | Last year 47,000 Americans had their blindness reversed through the transplantation of cells from a corneal donor’s final selfless act. It is safe, it is effective, and because it is curative, it is a relatively cost effective procedure. It is medicine at its most beautiful.

And according to FDA regulations, the distribution of this cell therapy is in violation of federal law.

That’s right. The regulation says that no matter how competent the surgeon, the FDA must first approve cells from donated corneas as if they were a drug—a process that takes over a decade and can costs billions of dollars — all for a practice that has been successfully restoring sight for more than 50 years.

The good news: the FDA doesn’t always adhere to its regulations and has not in this case.

The bad news: inconsistent enforcement creates uncertainty, deterring innovation for other unmet medical needs such as arthritis, back pain, and diabetic ulcers.

Read more at Fox News.

The Senate Must Streamline the Drug Regulatory Process (Wall Street Journal)

WALL STREET JOURNAL | Before the Senate is a powerful medical-innovation package of 19 bills—a companion to the House-approved 21st Century Cures Act—that will streamline the nation’s regulatory process for the discovery, development and delivery of safe and effective drugs and devices, bringing the process into the new century. This legislation, crafted by the Senate’s Health, Education, Labor and Pensions Committee, touches every American. Each of us has personal health battles or knows family members and friends who are fighting against devastating diseases. Passing this package will help ensure that patients’ perspectives are integrated into the drug-development and approval process and speed up the development of new antibiotics and treatments for those who need them most.

Read more at the Wall Street Journal (sub required)

Four Strategies to Save Lives, Curb Smoking (Forbes)

FORBES | This  month, FDA passed The Tobacco Control Act, which grants the Agency the authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products including e-cigarettes and hookah pipes. The truth is, smoking and tobacco take 500,000 lives in the US each year, and healthcare for a smoker costs the system $18,000 more than for nonsmokers.

This is an all-hands-on-deck issue and we need a combination of efforts and approaches to make lasting change. I present four effective approaches at Forbes.

Read more at Forbes.

Congress Must Act Now to Improve School Nutrition (The Hill)

THE HILL | While headlines harp that the U.S. is a nation “hopelessly divided,” there is something lawmakers can band together on: forging a solution to our obesity epidemic.  In addition to being one of the greatest health threats our nation has ever faced, it is a terrible burden for employers, who are forced to spend more than $73 billion in costs associated with overweight-related medical and lost productivity costs every year. Obesity also threatens national security, as the leading medical reason why 71 percent of young adults between the ages of 17 and 24 cannot qualify for military service.

Read more at The Hill.

Spring Update (Newsletter)

So much of my work is a balance of progress and conservation. Now, more than ever, that’s playing out at home. Tracy and I are working to turn Old Town, our Williamson County home on the Old Natchez Trace, into a thriving farm while preserving and honoring the property’s centuries-old history. We welcomed new members to our family this month. Pryor Lillie the calf is named after Old Town’s 1846 builder. Two new colts, Risa and Ray, will join us at Old Town next month. And Nickle, our little Australian Shepherd, keeps us all in line. At the same time, we’re working closely with Kevin Smith, a local archaeologist and anthropologist to preserve the 800-year-old Mississippian temple mounds that serve as the foundation for Old Town.

As always, we love welcoming friends from all over the country to Nashville. With Kix and Barbara Brooks we hosted a delegation from California a few weeks ago, touring some of the best of Nashville: the Bluebird Café, Vanderbilt, and the Frist Visual Arts Center. And I never miss the Mule Day Parade: an annual event in Columbia, Tennessee, dating back to 1840.

Today we begin two weeks of travel that will encapsulate that same push and pull. Before we go, I wanted to share with you some of what we’ve been up to and some of the important work ahead of us. We will be sharing details of the trips and what we learn on social media. Follow along on Twitter (@bfrist) or Facebook (SenatorBillFrist).

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Cellular Horizons Conference, the Vatican

We will be representing Hope Through Healing Hands and the Bipartisan Policy Center at the Vatican this week at the Cellular Horizons conference (#UniteToCure) to discuss the latest in regenerative medicine. I’ll be speaking on the Speeding Cures panel—an issue that weighs heavily on me. Late last year BPC recently released a report that I co-chaired with Representative Bart Gordon on cellular therapeutics. In the report, we encourage Congress and others to work to advance medical innovation legislation. This will require changes at FDA and in how research is structured. There’s an act pending in Congress now to apply some of these needed changes. The REGROW Act is bipartisan, bicameral legislation based on the BPC’s December report and would create an expedited approval category for adult stem cell therapy that would allow for conditional approval after Phase I and Phase II trials are complete, and evidence of safety and effectiveness is demonstrated. This could make a huge difference for how quickly we can develop life-saving drugs.

The Nature Conservancy Global Board of Directors, China

For the first time ever, the Board of Directors will visit TNC’s projects in China, and we are thrilled to be able to see some of the conservation projects underway in Sichuan, Beijing, and at 3 Gorges Dam. TNC’s goals in China include establishing land trusts, reforestation efforts, and working with the 3 Gorges Company to ensure the survival of the fisheries and communities downstream from the dam. All of this is important work, and we are anxious to be on the ground and see the progress being made.

NashvilleHealth & Domestic Health Reform

Hope Through Healing Hands & Global Health

State Collaborative on Reforming Education (SCORE)

  • All children should be educated and equipped for their futures. But how to best do that? SCORE launched a SCORE Institute in partnership with Project Renaissance to look at how students move from poverty into the middle class.
  • Community partnerships are working for education in Tennessee. SCORE highlights four that can be models of success.
  • SCORE’s Executive Chairman and Chief Executive Officer, Jamie Woodson, explains the new statewide report Equitable Access to Highly Effective Teachers for Tennessee Students and lays out the first steps toward addressing Tennessee’s “effective teaching gap”.

Tomorrow Might Be The Most Important Day This Year (Forbes)

It’s true that we are all living longer: the percentage of American adults over 65 years old has doubled since 1940, now reaching 13%. By 2050 that number is expected to double again to 25%. In actual numbers this translates to an estimated 89 million “senior citizens” by 2050.

Advances in sanitation and the advent of antibiotics has been responsible for much of this shift, and researchers continue to probe how changes in diet, medications, and genetics can slow or stop the process of aging. Artificial life preserving technology, transplantation, and advanced chemotherapies have transformed once fatal diseases into chronic illnesses. But living longer does not necessarily mean living better. Our ability to maintain the basic presence of life with medicines or machines does not mean we can continue to preserve the essence of the person that came before. We are still mortal, and we do eventually die.

Therefore, it is vitally important that you think about the type of health care you desire to receive as you approach the end of life. Saturday is National Health Care Decisions Day—April 16, 2016. Plan a time now to write out or update your personal wishes for your end of life care.

Read more at Forbes.

Improving Access and Adding Value for Mental Health Care (Forbes)

“When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out,” 24-year old Amanda explained to Kaiser Health News. Amanda was diagnosed with bipolar disorder in college, after several years of manic-depressive behavior. The family struggled financially and emotionally to get Amanda the best possible care, fighting against an outdated health system that is failing those with behavioral health needs.

It shouldn’t have to be that hard. We must change how we offer mental health care.

Read more at Forbes.

Charleston Helps Mothers and Children Globally (The Post and Courier)

This week, global health non-profit Hope Through Healing Hands (HTHH) seeks to galvanize the work already being done in Charleston and South Carolina around an important health initiative. HTHH will co-host a luncheon with faith leaders, nonprofit leaders, university leaders, and others in Charleston to discuss how we can better unite on behalf of child and maternal health globally.

Read more at The Post and Courier

Global Health: The Most Effective Policy

As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional. In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home.

Read more at The Hill.

Cutting Sugar for Better Health

On a trip this month to the U.K., I noticed many of their food and beverage products labeled “No Added Sugar,” and the message floods the airwaves. Britain has already caught on to the evils of hidden sugars, and has been loudly making it known to consumers. America should follow suit.

Reducing sugar intake isn’t just about losing weight or preventing cavities. Americans’ excessive sugar consumption poses tangible health risks. An April 2014 study published in JAMA Internal Medicine found “a significant relationship” between added sugar consumption and increased risk for cardiovascular disease mortality. Those who consumed a quarter or more of their daily calories from sugar were twice as likely to die from heart disease than those with daily sugar intake of 7% or less! As a heart surgeon, these are numbers I notice.

Read more at Forbes.

Flint’s Water Crisis and Public Health 3.0

When looking at the ongoing crisis over safe drinking water in Flint one thing is abundantly clear, the decisions made–at multiple levels–were made without a comprehensive evaluation of the impact on public health.

Karen DeSalvo, Acting Assistant Secretary for Health and National Coordinator for Health Information Technology, and I take a look at the public health approaches  being used to help the residents of Flint react to, and recover from, the consequences of the elevated levels of lead in their drinking water. In our own practices as physicians, we know that a well-rounded care team is crucial. But in public health we tend to deploy this multi-sectorial approach only in response to public health failures rather than using their full potential to improve health outcomes and prevent public health emergencies like we see today in Flint.

We believe now is the time for public health professionals to take on larger, more engaged roles as civic leaders, and for business leaders to invest fully in the health of their communities.

Read more at Forbes: What the Flint Water Crisis Reveals About Public Health

Health Diplomacy in Latin America

Strategic Health Diplomacy (SHD) recognizes that targeted global health initiatives can be an important foreign policy tool for the United States.  Healthier populations are productive, safe, and less vulnerable to instability. By addressing global health in Latin America and the Caribbean (LAC), the United States can save lives and improve its national strategic interests.

Read more at Kennedy School Review: An Application of Strategic Health Diplomacy in Latin America and the Caribbean: The U.S. Southern Command

A Cancer Moonshot With A Clear Plan

The Obama administration announced on Monday that it hopes to spend a total of a $1 billion to fund a cancer “moonshot” in search of cures. That amount is likely not sufficient, but it can establish the framework by which the goal can eventually be met.  It is critical that under this rallying cry we articulate a clear, cogent plan to achieve the goals articulated by our government leaders.

Read more at Forbes: Cancer ‘Moonshot’ For Our Generation

Congressional Challenges for 2016

2015 was Congress’s year. For the first time since 2011, both chambers of Congress were led by the same party. Leaders of both the House and Senate worked together on legislation instead of against each other. It was an about face. Unfortunately, election years are notoriously less-productive. But with bipartisan commitment, we can continue to reap the benefits of a Congress that has gotten back to doing the people’s work.

Read more at Forbes: Can Congress Be Productive–Again?

What’s Needed to Remain Competitive in Medical Innovation

Less than a week ago, Congress voted to increase the NIH budget by $2 billion. That’s a lot of money, but it only just reverses the erosion of federal funding for critical biomedical research. This funding increase is much-needed. But there’s more than can be done on Capitol Hill to re-prioritize lifesaving biomedical research.

Read more at Forbes.

Season’s Greetings

Merry Christmas all! Tracy and I hope this holiday season brings peace and joy and 2015 was a rewarding year.

It’s been a fall of new beginnings for us in many ways. After three sons, and two grandsons, our family welcomed our first granddaughter, Amelia Fearn Frist, just over a month ago. We launched a pioneering new health initiative for Nashville that we believe will serve as a model nationwide. And most importantly, Tracy and I were married this summer in Sinking Creek, Virginia, where we have a farm where Tracy runs her grass-fed beef business. We’ve since opened a satellite branch in Williamson County. We are now in the cutting horse business in Franklin, Tennessee, expecting two new babies in April at our farm, Old Town. Tracy has had her hands full training a surgeon to be a cowboy.

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Domestic Health Reform

But it’s not been all grass-fed beef and cutting horses this fall. Much of our work has been focused on launching NashvilleHealth, an endeavor meant to change Nashville’s health outlook. Although we are a national hub for healthcare, our citizens are not all benefitting from the talent, expertise, and resources we have here. NashvilleHealth will be a county-wide convener to open dialogue, align resources and build smart strategic partnerships to create a plan for health unique to Nashville’s needs, leveraging the rich resources of our city and region.

NashvilleHealth has been a big undertaking, but it hasn’t been the only thing we’ve been working on. The Nashville Health Care Council has announced its 2016 Fellows Class, a one-of-a-kind executive program on which Larry Van Horn from Vandy’s Owen School and I work. We’ve also been writing on antibiotic resistance, a growing and extremely serious problem, and health care technologies, especially telemedicine. We are closely watching the health delivery on a national scale, encouraging AHRQ and calling for reform at the VA, bringing attention to health issues for children and the elderly, and continuing to argue for needed refinements to the Affordable Care Act. We continue to use writing and social media as the primary means of changing the culture around many of these issues.

Hope Through Healing Hands & Global Health

Tracy and I visited Cuba again this year, this time searching for a family doctor. On previous trips we’ve seen hospitals and clinics, but the patient’s first contact has been the missing link. This fall, we made a surprise visit to a Cuban family doctor, and got to see what medicine there really looks like.

We’ve been forever impacted by our visits to Cuba, and late this summer Tracy and I launched Mountain AIR, an artist-in-residence program at our Virginia farm. Hector Frank, an incredibly talented Cuban artist, is our first resident. We’ll be headed back to Cuba next month.

We’ve also worked this year to spread understanding of global health’s role in our national security. PEPFAR stands as a shining example of what a concerted effort for global health can mean for our country’s health and safety at home, but now more than ever we must be active and visible.

SCORE & Education

SCORE continues to soar. The State Collaborative on Reforming Education once again celebrated the hard work of Tennessee students, teachers and administrators at the SCORE Prize event. ABC’s Nashville star Charles Esten—Deacon Claybourne—was on hand to perform as we named twelve schools and districts as finalists for the coveted SCORE prizes.

I’m even more excited than usual for SCORE’s next year. Last week SCORE announced a new strategic plan, refined the leadership structure, and launched a strategy to 2020 with goals including closing achievement gaps by income, race, and geographic location; preparing all graduating seniors for post-secondary education; and continuing our impressive state-wide improvement.

More bits:

  • If you’re in Nashville and you have a car, you must check out Yoshi. I’m not unbiased, but I am genuinely thrilled with the time it saves. You will never have to fill your own gas tank again!
  • If you’d like newsletters like this by email, sign up here. Or, you can subscribe directly to the articles posted on our site.
  • A patient of mine is thriving 25 years after a lung transplant. It’s an amazing story. She’s a fighter—the longest living lung transplant in America.
  • Again, happy holidays, and here’s to a wonderful 2016.

 

 

 

The Childhood Experiences That Can Cut 20 Years Off Your Life

I recently heard a startling statistic. According to a CDC study, children who endure six or more adverse childhood experiences (ACEs) by the age of 18—incidents of abuse or neglect that make a child feel unsafe or unwanted in their home—live on average 20 years less than their peers who are not exposed to these ACEs growing up. Furthermore, those with four or more ACEs are seven times more likely to be alcoholics in adulthood, twice as likely to develop cancer, and sadly, twelve times more likely to commit suicide. They lead sicker, shorter lives. And they often pass those disadvantages on to their own children by recreating the traumatic environments that they grew up in, perpetuating a toxic cycle.

What does a childhood with multiple adverse experiences look like? It could be a girl of divorced parents, whose mother is abusive and suffers from mental illness. It could be a young boy who is being raised by his grandparents because both his parents are addicts and incarcerated. It could be a child whose father committed suicide after years of struggling to make ends meet to feed and clothe his children. These are some of the more troubling cases. But nearly two-thirds of Americans report having one or more ACE, and more than one in five report three or more ACEs. Childhood stressors are increasing the likelihood of illness and addiction for a meaningful portion of the U.S. population–and our healthcare system fails to address this key driver of health.

Read more (and take the ACE quiz) at Forbes.

The Numbers are In: The Case for NashvilleHealth

I like to keep an eye on my hometown’s statistics. I love seeing Nashville listed among the nation’s best cities to launch a startup, raise a family and visit for a weekend away. According to some estimates, we gain 80 new Nashvillians each day, transplants from all over, drawn to our welcoming atmosphere and our healthy business environment.

But for many of Nashville’s residents, “healthy” is not an apt descriptor. I’ve been closely watching these numbers, too. Nashville’s citizens have some of the worst health outcomes on a national and global level. Tennessee is one of the unhealthiest states in the country: 45th out of 50. And Davidson County ranks 22nd out of Tennessee’s 95 counties for health factors, according to the Robert Wood Johnson Foundation County Health Rankings.

To address these challenges, I am launching NashvilleHealth to create a comprehensive and bold, community-supported culture of health equity in Nashville. NashvilleHealth will serve as a county-wide convener to open dialogue, align resources and build smart strategic partnerships to create a plan for health unique to Nashville’s needs, leveraging the rich resources of our city and region.

Read more at the Nashville Post.

Retreating From Global Leadership Puts America at Risk

The 2016 presidential campaign is well under way, and the candidates are already jousting over who is best suited to respond to an increasing number of obstacles abroad, ranging from the refugees crisis in Europe and the Middle East, to the threat of ISIS, to Russian aggression under President Vladimir Putin. As Democrats and Republicans, the four of us will almost certainly support different candidates in November 2016. But we all agree on this: Our security and prosperity are at risk if America retreats from our leadership responsibilities around the world.

There could not be a riskier time for America to pull back.

Madeleine Albright, Tom Daschle, and I explore why today in Time.

What PEPFAR’s Numbers Mean for National Security

As of last year, PEPFAR supported anti-retroviral treatment for 7.7 million people, mainly in Sub-Saharan Africa, and an astounding 95 percent of at-risk babies were born HIV-free. In 2013, Secretary of State John Kerry announced that the one-millionth baby had been born HIV-free because of PEPFAR-supported prevention of mother-to-child transmission. No nation in history has been responsible for a larger or more successful global health program. Yet it appears PEPFAR has accomplished much more than saving lives.

Tom Daschle and I look at the PEPFAR numbers at US News & World Report.

The Superbug Fight at your Grocery Store

You may have heard statistics about the over-use of prescription drugs, with reports indicating that up to half of all antibiotics prescribed today are used improperly. It’s a huge problem contributing to the rising threat of antibiotic-resistant bacteria. What you may not have heard, however, is that the majority of drugs used in the U.S. aren’t even taken by humans. Approximately 70% of medically important antibiotics are sold for use in livestock.

This is a trend that started in the middle of the 20th century when farmers began putting small doses of antibiotics in the food, water and minerals of animals for growth promotion, disease prevention, and disease control. It became standard practice and seemed to make sense – keep the animals healthy, increase growth, produce more food, increase farm profits, and lower food costs for consumers. It is even attributed with tripling American meat production over the last 50 years. But the reality hasn’t been that simple. A side effect we hadn’t anticipated was antibiotic resistance, and in turn, higher health care costs.

Read more at Forbes.

In Memory of Fred Thompson

Today Tennessee lost a talented and admired statesman and many of us lost a beloved friend. Working at his side in the Senate for 8 years, Fred embodied what has always been the best of Tennessee politics—he listened carefully and was happy to work across the aisle for causes that he believed were right. My thoughts are with Jeri and their children at this time; he will be missed.

Congratulations to the 2015 SCORE Prize Winners

All year long the State Collaborative on Reforming Education—SCORE—works with and for students, parents, and teachers in Tennessee and each October we have the privilege of dedicating an evening to recognizing the amazing progress they have made. I love that our annual SCORE Prize awards ceremony doesn’t just bring together administrators and policy makers in education, but also teachers and students from across the state. It’s a lively crowd and one of my favorite nights of the year.

This year I was particularly thankful to have Tennessee Governor Bill Haslam and our Education Commissioner, Dr. Candice McQueen, join me in recognizing the hard work of our schools across the state, and I think the whole crowd was thrilled that ABC’s Nashville star Charles Esten—or Deacon Claybourne—was on hand to perform for us.

The SCORE Prize is an opportunity to lift up successful schools and districts across Tennessee and share best practices with each other. These awards are earned based on data collected by our SCORE Prize Selection Committee. They spend weeks examining data and visiting schools and districts across the state to determine the best of the best. Watch the video to see how the SCORE Prize winners are chosen. I offer them my sincere thanks.

This year’s winners again raised the bar on excellence in education. Together they are pushing Tennessee forward for the sake of our children and future.

Elementary School Finalists:

  • Delano Elementary School in Shelby County (2015 winner)
  • Andersonville Elementary School in Anderson County
  • Dresden Elementary School in Weakley County

Middle School Finalists:

  • New Vision Academy in Metropolitan Nashville Public Schools (2015 winner)
  • Grassy Fork Elementary School in Cocke County Schools
  • KIPP Academy Nashville in Metropolitan Nashville Public Schools

High School Finalists:

  • The Soulsville Charter School, Shelby County Schools (2015 winner)
  • Covington High School, Tipton County Schools
  • Martin Luther King Jr. Magnet School, Metropolitan Nashville Public Schools

School District Finalists:

  • Trousdale County Schools (2015 winner)
  • Dyersburg City Schools
  • Johnson City Schools

You can learn more about the winning schools here.

I was also particularly impressed with the individual students who were honored for their work. The Students Rise to the Challenge (SRTTC) scholarships award $1,000 to a student in each age category for an essay or video describing how one of their teachers helped them overcome an academics challenge.

Weston Downing, a 12th-grade student at Covington High School in Tipton County Schools; Yeleeya Li, a sixth-grade student at Indian Trail Intermediate School in Johnson City Schools; and Nicholas Reynolds, a fifth-grade student at Andersonville Elementary in Anderson County Schools, all did outstanding and creative work and paid worthy tribute to the teachers in their lives. You can read and watch Weston’s, Yeleeya’s, and Nicholas’s prize-winning entries here.

Congratulations to all of the SCORE Prize finalists and winners, and thanks to the SCORE Prize Selection Committee, Jaime Woodson and the outstanding SCORE team, and all of the students in Tennessee who keep pushing us forward.

Making Health Convenient

I believe one of the secrets of achieving good population health is to make the healthy choice the easy choice, and I’m so pleased to learn of businesses in Tennessee who are working to make that a reality. Tri-Star Services’ Twice Daily convenience stores are making a strong committment to offering  healthy food and drink options in their Tennessee locations. I believe it will be a great model for others to emulate.

Read more in The Tennessean.

In Search of the Family Doctor

Over the course of three visits to Cuba in the past year I have learned much about this nation, its people, its art, and its healthcare system.  We’ve toured polyclinics, hospitals, and medical schools. I’ve met with professors and medical students.  We’ve gotten the government’s healthcare statistics and double checked those with providers on the ground. I’ve seen facility standards that are disappointing and observed shortages of the most basic medical supplies and pharmaceuticals. But everyone I have met on the street knows and respects their local doctor, assigned to them by the state. They have all described their doctors as accessible, empathetic, and caring. So my goal for of this trip was to make an unplanned and unannounced visit to this front line: to visit a family practice doctor who is the fundamental link connecting every person to healthcare delivery.

Read more at Forbes.

Doing the Hard Work for a VA Transformation

It was over a year ago that the public learned of unacceptably long wait times and false record keeping at the Department of Veterans Affairs, resulting in shoddy care for our service men and women. Since then, instead of progress, we have been met with ongoing reports of delayed care, wasteful spending, and poor management.

Last February some colleagues and I presented an array of concrete and actionable proposals for VA health care reform in a report, “Fixing Veterans Health Care.” The report was the product of a six-month process of careful study and deliberation through which our bipartisan task force identified key challenges in the VA health care system and developed workable solutions.

Now we need everyone’s voices to make lasting change.

Read more in the Military Times: http://www.militarytimes.com/story/military/benefits/veterans/2015/10/04/commentary-making-case-va-transformation/73213092/

The Future for The Agency for Healthcare Research and Quality

Research matters. An agency that I fought to save many years ago is at risk again, and Congress must make a move to save it.

I had just been sworn into the U.S. Senate in 1995, when I first found out that the The Agency for Healthcare Research and Quality (AHRQ) – then known as the Agency for HealthCare Policy and Research (AHCPR) – was on the chopping block. I was still unpacking boxes and learning my way around the Senate halls when my good friend and teacher Uwe Reinhardt of Princeton came to me with an urgent request. He reported the federal agency responsible for funding and conducting health services research was in danger of being eliminated in the 1996 Congressional budget. The AHCPR, which had been renamed and reorganized just six years prior with strong bipartisan support and a revised mission, had fallen out of favor with several influential members of the House Budget Committee.

More at Forbes.

Call for a Conversation: Alzheimer’s in Tonight’s Debate

Tonight, when Republican candidates, vying for the White House, debate one another at the presidential library and final resting place of President Ronald Reagan, they should honor his memory and address the illness that claimed his life and the lives of 700,000 Americans annually: Alzheimer’s disease, the sixth-leading cause of death in our nation.

Reagan was a true patriot. He led this country with boldness and tremendous strength. His optimism helped fuel our country’s continued ascent to greatness, even during difficult times. Just five years after leaving the White House, on Nov. 5, 1994, Reagan issued a letter to the American public announcing, “I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer’s disease.”

That was more than 20 years ago, and this frightening disease is only becoming more prevalent. As baby boomers (now 51 to 69 years old) age, more Americans are at risk of developing the disease than ever before. None of us will be untouched.

Read more at US News and World Report.

Nashville’s Role in the Healthcare Landscape

I love Nashville and I’m so proud of the work being done  here. Healthcare is the heart of this town and the solutions being developed here are helping patients all over the world. I’m particularly proud of the Nashville Healthcare Council’s Fellows program, and was thrilled to introduce it to a broader audience.

I am constantly inspired by the sheer volume of creativity in Nashville, much of which is channeled toward shaping a smarter, more efficient health care system for our nation.

I was only 16 when my father and brother co-founded HCA in 1968, an innovative venture that grew into the largest hospital management company in the world and reshaped the delivery of care throughout the country. HCA’s founding helped set the stage for Nashville to become the epicenter of the American health care industry, today home to 400 health care companies.

I advise a number of cutting-edge organizations, and I consistently see tomorrow’s successful, shareable care-delivery models being built in Nashville. Future generations of patients across the world stand to benefit.

Read more at Modern Healthcare.

The Virus Wars: Vaccines that Work and Why We Aren’t Using Them

Researchers around the world are scrambling to find an Ebola virus vaccine. Rightfully so. The virus infected nearly 28,000 people and killed over 10,000 in Africa since last year’s outbreak began. But there are other viruses with even more staggering numbers: HPV–human papillomavirus–killed 230,000 women last year. 170,000 more were diagnosed with cancer, but survived.

And yet, we have a vaccine for HPV. Current versions can kill 70% of HPV strains. But in the United States our vaccine rate for HPV is abysmal. A proven-safe vaccine can snuff out a virus that we know causes deadly cancer. Yet only 35% of the recommended population gets the vaccine.

The time for excuses is over.

More at Forbes

Hector Frank and a New Opportunity for Cultural Unity

Last October, Tracy and I visited Cuba and got an up close view of the country, the people, and their challenges. I’ve written about my impressions of their healthcare structure–in many ways woefully lacking, but with some surprising lessons for us in America. What I didn’t write quite as much about was the art. We found the art and the artists in Cuba inspiring, bold, and visionary. I loved what they were doing and how their work was crossing borders and boundaries, even against great odds.

I’m sure you know that I believe health is a powerful tool for diplomacy. But art can be just as unifying–recognizing and communicating our common hopes and struggles like little else can. The creation and sharing of art among peoples around the world evokes cultural understanding and shared unifying dreams.

For that reason, Tracy and I are thrilled to launch today the Mountain Artist in Residence (Mountain AIR) initiative, and introduce the first artist in residence–the man whose work inspired this project–Hector Frank from Havana, Cuba. We will welcome Frank with an exhibit today–Cuban Summer 2015, benefitting Hope Through Healing Hands and SCORE. In the fall, Frank and his wife Teresa take up their residency. We are excited to see what happens next!

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About Hector Frank

Hector Frank was born in Havana, Cuba in 1961. Hector continues to be influenced by Cuban and the Caribbean artists working with strong forms and lines.  He incorporates impasto techniques along with various mixed media and collage to build his images up off of the surface and bring them to life.

From the start of Frank’s art career, he preferred to paint abstractly, and continues to be influenced by Cuban and Caribbean artists working with strong forms, and lines. Through drawing, he began expressing figurative forms in a variety of media including wood, handmade paper, and assemblage.  He incorporates impasto techniques along with various mixed media and collage to build his images up off the surface and bring them to life.  He works with mixed media and creates highly sought works on re-claimed wood with found objects. By changing his style often, he keeps in the forefront of the ever changing Cuban art scene.

Frank’s work has been shown in France, Mexico, Panama and the United States,and is featured in prominent private and public collections worldwide.

During his Mountain AIR residency, Frank will draw upon the natural environment and Appalachian setting to create a series of pieces in paint and in a materiel medium.  Abundantly available to him are natural materials, including reclaimed wood, wire, wood, copper, leather and glass that have accumulated on the property for the past hundred years.  His objective is to marry his traditional Cuban culture with the American Appalachian life in an interpretive fashion.

About Mountain AIR

Twice each year, an artist will be selected to spend two weeks living on a beautiful and inspiring 480-acre cattle and horse farm in Sinking Creek, Virginia, deep in the Appalachian Mountains with complete creative freedom. Our hope is to provide an environment encouraging to the individual’s creative and artistic sensibilities.  This majestic rural mountain setting amidst a working farm that includes grassfed cattle, sheep, horses, goats, and chickens provides an inspiring sense of time and place.

The artists will work out of a naturally lit, second floor loft above a working livestock barn with breathtaking, panoramic views of the flowing valleys and stream below and the mountains around. Artists have complete access to the farm including all the land, beaver streams, livestock, farmhands, and materials that have accumulated on the land over the years, as well as the Appalachian Trail and Jefferson National Forest. Artists are encouraged as they wish to actively engage in the farm life that so genuinely defines who we are as Americans.  They will have opportunities to interact with and introduce their art form to local K-12 children as well as writers-in-residence from regional higher educational institutions over two to three days.

Podcast: Medicare and Medicaid at 50

Fifty years after Medicare and Medicaid were created, healthcare in America is still rapidly evolving. Carefully observing where we’ve been will help inform where we are going, so in today’s special issue of the Journal of the American Medical Association (JAMA) Kaiser Family Foundation President and CEO Drew Altman and I look at the Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers over the past half decade. The full text of the JAMA article is available by subscription only, but Drew and I also discussed the piece and our findings with Dr. Preeti Malani, Associate Editor, The JAMA Network in a freely available podcast.

 

Telemedicine and the Tools of Care

At the Spotlight Health event at the Aspen Ideas Festival last month I had the privledge of speaking on a panel moderated by Steve Clemons. We focused on the Supreme Court’s decision on the Affordable Care Act and costs of healthcare in America. It prompted some thoughts about my dad’s medical practice many  years ago. Dad had a DeSoto, and that car took him to many house calls over the years. Of course a DeSoto isn’t the practice of medicine. It was simply a tool Dad used to meet his patients where they were. I think telemedicine is the same kind of tool, one that makes care infinitely better for patients.

More at the Health Affairs Blog

Compensating for End of Life Conversations Is Important First Step

The Obama Administration is soon scheduled to release the proposed 2016 Medicare Physician Fee Schedule, which determines what and how much providers can bill for health care services. The administration can choose to compensate providers for offering voluntary counseling services to patients and families about end-of-life care options, and I strongly urge it to do so. It is an important first step.

As a heart surgeon, I have seen countless instances where patients near the end of life undergo aggressive medical interventions in order to prolong the inevitable. Yet most people, when asked, say they would want to spend their final days at home, without pain, comfortable with family and friends, and not hooked up to multiple machines in the hospital. We simply must do better and help ensure that a patient receives the health care that they want near the end of their life.

Americans are living longer than ever, and children are increasingly helping aging parents and grandparents manage multiple chronic conditions. This new reality has more and more people thinking about new models of end of life care, and has sparked a national conversation about how we can all live well, until the very end.

I’m encouraged to see that this important issue has reached the halls of Congress, where legislators in both the House and Senate are pursuing bipartisan ways to improve the care patients receive near the end of life. One policy option being considered is reimbursing providers for discussing treatment options and care preferences with patients and their families. I wholeheartedly support this idea, and there is an immediate opportunity to make it happen.

Read more at Forbes.

 

Cuba’s Most Valuable Export

If you had to guess, would you guess sugar? Cigars? What about doctors and nurses?

The Cuban government reportedly earns $8 billion a year in revenues from professional services carried out by its doctors and nurses, with some 37,000 Cuban nationals currently working in 77 countries. The socialist regime allows the government to collect a portion of the incomes earned by Cuban workers abroad.

For example, in 2013 Cuba inked a deal with the Brazilian Health Ministry to send 4,000 Cuban doctors to underserved regions of Brazil by the end of the year – worth as much as $270 million a year to the Castro government. By the end of 2014, Brazil’s Mais Medicos program, meaning “More Doctors,” had brought in 14,462 health professionals – 11,429 of which came from Cuba.

Over the past 50 years, Cuba consistently used the export of its doctors as a powerful and far-reaching tool of health diplomacy. The island nation has built good will and improved its global standing with emerging countries around the world during its years of isolation. It sent its first doctors overseas as far back as 1963, and to date has sent physicians to over 100 countries.

More today at Forbes.

 

The Worst Kept Secret in Healthcare

For many of our health problems, the solutions are not a secret: eat well, move, make healthy choices. Of course sometimes that is easier said than done. Our physical and social environments–where we live, what kind of emotional support we have, our access to fresh food and healthcare–determine more of our healthcare than what our doctors prescribe. If we want to be serious about improving wellness, we must get serious about preventing health problems before they start.

The Bipartisan Policy Center launched a report last week looking at the best ways to incorporate prevention into our lives. Alice Rivlin and I announced the study:

In order to refocus on wellness, over the past year, the Bipartisan Policy Center convened a Prevention Task Force to determine how to change our nation’s health conversation so we are taking actions to promote wellness rather than focusing solely on providing reactive medical treatment after a person gets sick.

Today, the task force is releasing recommendations for achieving this goal, which include better connecting clinical providers and community organizations, and creating incentives to make preventive care a priority. As senior advisers to the task force, we strongly endorse the two-part framework today’s report outlines to more fully integrate prevention into the nation’s approach to health and health care.

Read more at US News and World Report.

A Charge to Press Forward on Alzheimer’s Research

Heart transplantation revolutionized healthcare in a way that’s hard to comprehend. What was once a death sentence–sometimes without warning–became surmountable. People got their lives back. We need the same revolution in Alzheimer’s research. The answer will be different; transplant can’t solve this problem. But just because the way forward is unclear, we can’t stop pushing forward. I challenge the 2016 Presidential hopefuls to keep Alzheimer’s disease at the forefront of research. We have so much to lose.

One in five Americans are obese. One in four has a risk of dying from cancer in their lifetime. But one in three that live beyond 65 will die with Alzheimer’s or another type of dementia. All these ailments have significant health impacts. The difference? We have solutions to treat obesity and can cure some cancers.

Alzheimer’s is the only disease among the top 10 causes of death in America that cannot be prevented, cured, or even slowed.

Read more at Forbes.

Why Texas is missing out on the future of medicine

If you’ve read much of anything here, you know that I am a big fan of health technologies to improve care and create a sustainable healthcare system. I think it’s essential that we choose the right technologies that will serve patients, and I firmly believe telemedicine is one of those solutions (so much so that I joined the board of advisors for Teledoc, a telemedicine company).

But across the country, thousands of people are desperate for accessible and affordable healthcare. For far too many of them, their only option—even for non-emergency care—is a $1,500 visit to the emergency room.

For example, 200 counties in Texas are considered medically underserved with 16 counties having just one primary care doctor and 27 counties having none. These citizens have nowhere to turn.

The good news is that a solution exists. It is called telehealth and has been increasing in use across the country over the last decade. However, a decision last month by the Texas State Medical Board will sharply restrict access for Texans by requiring in-person visits before you are allowed to use telemedicine. Previously, the board required doctors to establish a relationship with patients before giving a diagnosis or prescribing drugs, but its April 10 decision narrowed rules to state that “questions and answers exchanged through email, electronic text, or chat or telephonic evaluation or consultation with a patient” are not enough to establish a doctor-patient relationship.

Read more at Fortune Magazine.

Killing the superbug: A call for Congressional action

When Alexander Flemming accepted his Nobel Prize for the discovery of penicillin, he issued a warning to future generations: his miracle drug—responsible for saving millions of lives—could one day be useless.

“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them,” Flemming said. “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Seventy years later, Flemming’s nightmare scenario is coming true.

The U.S. Centers for Disease Control and Prevention (CDC) reports drug-resistant bacteria infect more than 2 million people nationwide, killing 23,000 annually. In addition to lives lost, infections cost $20 billion in additional direct healthcare costs, up to $35 billion in lost worker productivity, and $8 billion in extra hospital days. Given the knowledge and resources available to us, this is unacceptable. ​

We need a multi-pronged strategy to attack antibiotic resistance.

Read more at The Hill.

 

The Promises and Challenges of Precision Medicine

Only 15% of our health is determined by the healthcare we receive, the rest are the social determinants of health: environment, economic stability, access to care, education and community resources. Paying attention to that 85% is imperative, and precision medicine aims to take targeted genetic and molecular information and consider it in tandem with data about our environmental exposures and lifestyle choices. Integration of the smallest building blocks with the macro environment is exactly the direction in which medicine should be moving, and President Obama’s Precision Medicine Initiative is a needed step forward. But getting there will take some new habits, a new funding model and new technologies.

Read more at Morning Consult.

MCC: Foreign aid in action

Most people are surprised when they learn how little we actually spend on foreign aid. But as we know, global health issues know no boundaries. That’s why it is so very important that spend our foreign aid  money wisely. I’m at The Hill today discussing a model that I think does a great job.

Most Americans agree foreign aid helps improve our nation’s image globally and protects Americans’ health by preventing the spread of diseases.

In fact, it does more than that. Our comparatively small investment in foreign aid enhances national security by stabilizing weak states and helping to fight the causes of terrorism. It encourages economic development, opening new global markets for American business. And it supports our humanitarian goals and values, advancing peace and democracy.

Considering the benefits, the surprising truth is that the U.S. spends less than 1 percent of our budget on foreign aid, and that amount has been dwindling due to sequestration. At a time when we are faced with global unrest and budget cuts, we must make strategic investments in foreign aid programs that have a record of success.

The Millennium Challenge Corporation (MCC) is a prime example.

Read more at The Hillhttp://thehill.com/opinion/op-ed/240550-mcc-foreign-aid-in-action

A Conversation on Haiti

Last week, Hope Through Healing Hands and I had the honor of welcoming the former Prime Minister of Haiti, Laurent Lamothe, to Nashville. I’ve been to Haiti many times, and was thrilled to hear the latest updates on the quantifiable successes in Haiti over the last few years, namely in providing housing for those displaced by the earthquake and putting children back in school.

Jenny Eaton Dyer, Hope Through Healings Hands’ Executive Director, has all the details about the event on the HTHH blog.

 

It’s National Health Care Decisions Day: Who will you designate?

End-of-life planning is an important part of healthcare. It’s a refrain I’ve been repeating. I’ve called for changes in care models, payment schemes, and physician education. But all of the needed changes aren’t at the system level. There are steps that every individual must take as well.

Along with Gary Dodd, a palliative care nurse with years of experience, I’m at Fox News this morning talking about a conversation you can have to take to take control of your end-of-life care.

We know that at least 90% percent of Americans have heard of a living will, but still only about one third have one. Even among nursing home residents, only 65% have some type of Advanced Care planning documentation. This is not news in the health care community, but if we want to change these numbers we have to ask “why?”

Read more at Fox News.

 

 

Where Health And Environment Converge

An area of healthcare that has recently become very important to me is community transformation projects focusing on the social determinants of health: environment, economic stability, access to care, education, and community resources. Only 15% of our health is determined by the healthcare we receive, so looking at the other 85% is not only imperative, it is just good math.

At Forbes, I look at where health and environment converge, not just in our own backyards, but globally as well.

This past March, I met Luis Giuria at the Building a Healthier Future for America Summit.  He was smiling ear to ear when he and his beautiful family took the stage to talk about what an impact his environment has had on his life.

Luis was born in the South Bronx, and grew up eating inexpensive junk food because it was the easy, affordable option.  His hometown lacked safe playgrounds and he never learned the importance of exercise.  By age 27, he weighed nearly 400 pounds, had trouble sleeping, finding clothes that fit, and was prone to injury.  To be a good father and husband, and good to himself, he knew he needed a major life change.  That’s when he discovered Arbor House, an innovative low-income housing project in the Bronx that was designed to encourage physical activity.  Arbor House boasts indoor-outdoor gyms, play areas for children, a rooftop farm that provides fresh produce and clean air, and abnormally slow elevators that encourage residents to take the stairs.  Luis and his family moved into Arbor House, and it’s helped the whole family embrace healthy living. Luis has lost 200 pounds thanks to his new environment and other healthy lifestyle choices.

His experience shows where health and environment converge. Most people would still list exercise, diet, or access to affordable healthcare as the key determinant of health—and those are all important. But the most important factor is one that influences everything else: your zip code.

Read more at Forbes: http://www.forbes.com/sites/billfrist/2015/04/15/where-health-and-environment-converge/

The Mother & Child Project

I am thrilled to announce that a huge project of ours has finally come to fruition. Thanks to the team at my global health nonprofit, Hope Through Healing Hands, The Mother & Child Project is now available!

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The Mother & Child Project was compiled by Hope Through Healing Hands’ Faith-based Coalition for Healthy Mothers and Children Worldwide. In this important book, Melinda Gates, Kay Warren, Christine Caine, Kimberly Williams Paisley, Michael W. Smith, Natalie Grant, Jennifer Nettles, Jennie Allen, Amy Grant, and many other inspirational leaders, cultural icons, political experts, academics, and service providers tackle the important topic of maternal and child health in developing countries. Through personal narrative and compelling research, this book educates and inspires people of faith to join us in empowering mothers and children worldwide.

I’ve written a bit about the powerful role of maternal health in influencing communities for good, and I’m so proud of what this book accomplishes: an insider’s look into the way this most fundamental goal shapes cultures.

I hope you’ll read it, and see for yourself what power we wield when we speak out for mothers and their children.

Read Publishers Weekly review

Tackling Administrative Waste: The Promises Of Data Science For The FDA

Our healthcare system needs an overhaul in lots of areas and the FDA is not exempt. It’s slow, expensive, and cumbersome. Modernizing the FDA is now the focus of several initiatives including ones from Congress and the Bipartisan Policy Center. One of the top priorities: using data to speed the drug approval process without sacrificing safety.

In looking at the $2.8 trillion a year—20% of our Gross Domestic Product—that our nation spends on healthcare, we see that about $900 billion of that is waste and $248 billion can be attributed to administrative complexity. This costly complexity stems from the ACA, insurance regulations, and regulatory agencies in the U.S., including the Food and Drug Administration (FDA). The FDA in particular is a needed and valued part of healthcare in this nation – it just needs a serious overhaul.

The innovation bottleneck at the FDA has a real impact on Americans’ healthcare. One of every $4 spent by consumers each year is on an FDA-approved product, including drugs, devices, food, and tobacco. Expensive development and approval processes drive up those costs with an average drug taking about $1 billion and a decade to make it to market. With increased consumer cost-sharing, expensive drugs and devices are already becoming out of reach for many Americans. And for those facing a disease with potential life-saving treatment in trials, the clock is ticking entirely too slowly.

Thankfully, modernizing the FDA has become a key focus for Congress this year. I am leading an initiative through the Bipartisan Policy Center, a non-profit think tank in Washington, DC, focused on reversing this cost trajectory to improve affordability and availability of healthcare. We are working on strategies to advance medical innovation within the FDA, while reducing the time and cost associated with drug and device development.

One area I think shows significant promise is the use of “big data”.

Read more at Forbes: http://www.forbes.com/sites/billfrist/2015/04/15/where-health-and-environment-converge/

Notes from the Road: Hong Kong

I’m in Hong Kong right now attending some financial meetings and touring some infrastructure projects. It’s been an eye-opening trip so far. Today in a financial meeting, one of the smartest participants is an historian, a student of thousands of years of Chinese history.

He observed: “The era of a Dynasty always begins with low taxes and full treasuries and ends with high taxes and empty treasuries.”

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But it’s not been all meetings. We toured the Central Wan Chai Bypass and Island Eastern Corridor Link, currently under construction by AECOM. The Central Wan Chai Bypass and Island Eastern Corridor Link is 4.5 km in length and has six lanes of traffic. It’s scheduled to be completed by end of 2017. Impressive.

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AECOM is a global provider of architecture, design, engineering, and construction services for public and private clients (with a Nashville office!). In Hong Kong, the company early dominated the market for infrastructure architecture and construction; it’s responsible for more than half of the public works projects. Here, AECOM has 4,600 employees and accounts for one out of 800 workers in Hong Kong. Hong Kong has the fourth-largest harbor in the world, and AECOM built 100% of the container terminal. It will be building the new airport terminal, and the sewage water treatment plant.

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Telemedicine Is A Game-Changer For Patients, The System

The Affordable Care Act won’t address our physician shortage–a problem expected to grow to as many as 52,000 needed physicians by 2025. And for many, the ACA still isn’t providing actually affordable care. To bridge these gaps, we must find innovative ways facilitate hassle free access to a provider that is more cost-effective. There is a solution.

While 87% of Americans now have health insurance, overwhelming co-pays, high deductibles and a lack of primary care doctors still stand in the way of healthcare for many.

An average GOLD level plan—one of the more expensive, “better” insurance plans—still has a deductible of $2,000 for an individual, which approximately 40% of Americans cannot afford. Thirty-five percent of Americans already struggle with medical debt despite that 70% of those struggling have insurance. And by 2025, the United States faces a potential physician shortage of as many as 52,000.

For many, new health insurance is not providing access to affordable care, and the ACA will not address the physician shortage. To bridge that gap, we must find innovative ways facilitate hassle free access to a provider that is more cost-effective. Telemedicine is a growing model that is a part of the answer.

Read more in Forbes.

New Tennessee telemedicine law grows health care access

I am convinced that telemedicine is a crucial part of the solution for delivery of healthcare in the United States–care that isn’t yet affordable or accessible for all. Tennessee has made important steps toward ensuring telemedicine is an option for our citizens, but there’s more to do.

Telemedicine is in its infancy in Tennessee. Specialists at our university medical centers provide remote consultations and conduct virtual patient examinations. School nurses in rural counties use secure telemedicine links for consults. But it is vastly underused where the need is the highest: in the delivery of primary care.

Telemedicine can prevent an ER visit on a Saturday night and keep a busy Monday morning on track. Patients can avoid travel time, last-minute child care arrangements and a lengthy stay in the waiting room.

Telemedicine does not replace the need for a relationship with a family physician, but it does serve as a convenient, affordable and high-quality alternative to an unnecessary ER visit.

Last year, Tennessee became the 21st state to enact “telemedicine parity” legislation requiring that insurers reimburse licensed health care providers for services delivered remotely just as they would for in-person visits.

The legislation removes the wasteful financial incentive to having patients make a trip to an emergency room when a telemedicine consult would suffice. In both cases, the reimbursement to the provider would be the same. Tennessee’s parity law also includes TennCare, the state’s managed Medicaid program. The law was signed by Gov. Bill Haslam in April and became effective Jan. 1.

It’s a good first step, but Tennessee must go further. We need two additional assurances.

Read more at The Tennessean.

The Physician’s Role and End-of-Life

Over the past several months, I’ve been championing a revolution in end-of-life care. The care models need to change. Reimbursement strategies need to change. The way we think and talk about end-of-life needs to change.

And physician education needs to change. We, as doctors, need a new perspective on our role as healers and what that means when our patients can no longer be healed.

In the March issue of Academic Medicine (preprint available now), I look at the history of end-of life care, and consider how we should incorporate palliative care into our evolving healthcare landscape. As a preview to the academic paper, I’ve written a column at Forbes on some of the challenges.

This is a topic that deserves much thoughtful attention. I’d love your input.

Recent thoughts on end-of-life and palliative care:

Palliative Care: More than just end-of-life planning, Morning Consult, September 2014
Palliative Care: We know we need it, but how will the system pay for it?, National Institute for Health Care Management, September 2014
The Landscape of Long-Term Care, Aspen Ideas Festival session, June 2014
Bipartisan Policy Center Long-Term Care Initiative Launch, April 2014
NIC for Seniors Housing & Care Executives keynote, event preview interview, February 2014
Digitize your own advanced-care plan, The Hill, December 2013
End of life stories give us impetus to learn, Tennessean, December 2013
End-of-life care plan can ensure wishes are respected, Tennessean, November 2013
2013 Health Care Investors Conference report, November 2013
Elderly need options for palliative care, Tennessean, October 2013
We often avoid important conversation, Tennessean, October 2013
It’s never too early to discuss your final wishes, Tennessean, September 2013

Real Conversations: You and Me

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here, the overview of you and me here, and the conclusion. Then join the conversation on Twitter and Facebook: #Conversation2015

At the end of the day, everything on our list comes down to a simple question that we all have to ask ourselves: Do we care enough about each other – the health of our nation and our world – to commit to making a difference? Do we believe that compassion for those less fortunate is, or is not, a fundamental part of who we are as a people?

It can be argued that compassion once defined who we are as Americans. You can, if you wish, define it in terms of religious faith. You can call it social justice. Or you can simply describe it as true patriotism. But no matter how you define it, let’s start with a return to a fundamental and basic principle—that we care. We care enough about each other to not let children die because they can’t have access to a basic medication. That women and girls anywhere should not be put at risk simply to find safe drinking water. That we care enough to not allow our fellow citizens to die young because they are poor. That we care enough to make a commitment to protect our environment as the future home of our children and their children—even if it means less economic benefit can be derived from it.

I’m looking forward to 2015 as we dig deeper into these issues. Merry Christmas!

Real Conversation on Democracy

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of the right to vote here. Then join the conversation on Twitter and Facebook: #Conversation2015

Hand in hand with freedom of the press is the right to vote. We learn about each other by expressing our opinions and allowing both small and the large voices to be heard. Many of our most pressing problems are problems of the majority, but the majority often needs to spend its day performing sustenance activities, instead of advocating for its needs. The right to be heard has never been more imperative.

Today, only about one third of the world’s population lives in countries with full and free democracies. The majority of countries in Africa and Asia—the very parts of the world facing some of most pressing challenges to human health and welfare—are not included in this list.

Those of us with “the vote” must recognize that the process of voting is only a small part of the democratic process. But it is emblematic of personal freedom and should be the instigator of our conversations about these very real issues.

We must protect and exercise our own right to vote, and become champions for that same right for people living around the world.

Water for the World

Back in 2003 I was traveling in Mozambique with a delegation of Senate colleagues to take a closer look at U.S. policy on HIV/AIDS.  We found an HIV emergency, but we also identified a health need even more fundamental: access to clean water.

That was the trip that prompted PEPFAR, President George Bush’s unprecedented commitment to address the HIV crisis. But it was also the trip that spurred advocacy for the dire need for safe drinking water, sanitation and hygiene (WASH).

At Forbes on Thursday I wrote a bit about the history of U.S. water legislation.

On Friday, the President signed into law the  the “Senator Paul Simon Water for the World Act of 2014”. It’s been a long time coming: the result of the work we started in 2003 as well as the tireless advocacy of so many other lawmakers and champions since that trip.

I’m thrilled to see the hard work of so many people come to fruition!

 

Real Conversation on Creative Freedoms

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of creative freedoms here. Then join the conversation on Twitter and Facebook: #Conversation2015

Creativity and freedom of expression are essential to dialogue and truth, and these are essential to democracy. The ability to express your ideas, critiques and concerns should be a basic right, but even in 2013, 70 journalists were killed and over 200 were in jail—murdered or imprisoned because their free thought represented a threat to those in power. Over the past five years, over 400 journalists worldwide were forced into exile.

Fear of expressing an opinion—for whatever reason—threatens the very fabric of our world.

Real Conversations on Population

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of population here. Then join the conversation on Twitter and Facebook: #Conversation2015

Almost all of the problems of the world today either stem from, or are worsened by, overcrowding. In October, 2011, the world’s population passed the 7 billion mark. And this has happened quickly. There are twice as many people on the earth today since the end of the Baby Boom.

We value life and want to prolong and enhance it, but given the issues previously discussed, the reality of population growth is something we cannot continue to ignore. A scientific and compassionate approach to education around and provision of acceptable birth control methods has never been a greater imperative. We need to move past the political barriers in the area to do what needs to be done.

Real Conversation on Children

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of children here. Then join the conversation on Twitter and Facebook: #Conversation2015

Over six million children die per year before they reach their fifth birthday, which is over 750 children per hour. And half of these deaths are preventable – and cheaply preventable. They include pneumonia, for which we need generic antibiotics, diarrhea due to unclean water, malaria preventable by mosquito nets, and measles for which we have a vaccination that costs $1.

Half of the over six million children who die every year are dying not because they have diseases that can’t be cured or prevented, but because they have diseases that we are not curing and preventing.

Then consider statistics on maternal and newborn health. Hope Through Healing Hands is leading an awareness and advocacy initiative to promote education and action for maternal and child health, with a special emphasis on healthy timing and spacing of pregnancies.

Healthy timing and spacing of pregnancies saves lives. We know that if young women in developing countries delay their first pregnancy until they are 20-24 years old, they are 10-14 times more likely to survive than those who have babies when they are younger.

If these women are able to space their children every three years, their newborns are twice as likely to survive their first year.

#Conversation2015

I recently got together with a couple of friends, entertainer WK “Big Kenny” Alphin and Dr. Randy Wykoff to talk about American compassion and to make a list: a list of things we should really care about. We wish to start a national conversation to identify and address some of the greatest threats to our global community. We are too privileged and have the advantage of too many lessons from history to continue to ignore our current trajectory – to continue to let another Ebola epidemic unfold as it did.

For my part, I frame the conversation in terms of changing health. American rhetoric regarding our national pride and values has taken many forms over the years, and until recently, health has not been a part of that conversation. But a focus on the social determinants of health, the basic tenants of our societal infrastructure, is imperative if we ever hope to build a society that can deftly and efficiently respond to and survive crisis.

This month, Big Kenny, Randy and I launched a conversation for caring, for change, for action. #Conversation2015 will focus on twelve issues for the next year. Picking twelve items was a daunting task, but we looked for opportunities where a little progress aided by a lot of compassion could make a big difference. To do that, let’s focus the dialogue on identifying those challenges threatening people’s health around the world, and how we can work together to address them. Join the conversation. Research these issues yourself and learn as much as you can and share what you learn with us.

Are you ready to take your place? Are you ready to care?

Read  my introduction in the Morning Consult

#Conversation2015 Issues (Links will update as we move through the list)

Safe Food and Water
Environmental Damage
Poverty and Inequality
Natural and Man-Made Disasters
Epidemic Diseases
Children
Population
The U.S. Criminal Justice System
Education
Creativity and Freedom of the Press
The Right to Vote and the Democratic Process
You and Me

 

Real Conversation on Disaster

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of natural disasters here. Then join the conversation on Twitter and Facebook: #Conversation2015

Natural disasters are a threat in and of themselves, and my friends and I have all witnessed first hand the destruction caused by hurricanes, earthquakes with tsunamis, and famine. As a society we are good at reactionary assistance – sending in the dollars and aid workers after the disaster strikes.

But many disasters are slow to occur and all disasters in an unprepared community – one with the issues of clean water and poverty to begin with – will wreak infinitely more havoc than they would on a well established community.

When an earthquake hits Haiti, when flooding overruns Bangladesh, or when famine starves the Horn of Africa, the impact is often magnified because of the challenging conditions in which the people were living before the disaster struck.

Lack of food, lack of economic opportunity, lack of education—all contribute to a much worse impact from any natural or man-made disaster. These are the “slow motion” disasters—just as devastating, but taking place over a longer period of time.

Can we as a society respond to both the “fast” and “slow” disasters with the same level of compassion and commitment?

 

Real Conversation on Poverty

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of poverty here. Then join the conversation on Twitter and Facebook: #Conversation2015

Poverty is inextricably tied to poor health. The world’s least healthy people often live in the poorest countries. Even in the U.S., a person in the lowest income bracket is about three times more likely to die before the age of sixty-five than someone in the wealthiest bracket. Poorer Americans are more likely to suffer from asthma, diabetes, high blood pressure, obesity, and heart disease and cancer.

But in the four decades since the war on poverty began, the gap between the richest Americans and the poorest Americans has actually grown. This is detrimental to the fate of our society because of its impact on children. Children born into poverty often remain there. Breaking the cycle of poverty by creating real opportunities is necessary to allow these children to become contributing members of our national family.

If we aren’t addressing poverty, we can’t improve health. If we aren’t thinking about poverty, we aren’t really considering the staggering level of injustice and inequality in the world.

 

Real Conversation on Environmental Damage

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of environmental damage here. Then join the conversation on Twitter and Facebook: #Conversation2015

Whether we are talking about global warming, strip mining or natural habitat destruction, the tension between economic interests and environmental concerns are becoming more tangibly apparent. We can now see the destructive impact our predecessors have had on the planet. Given this trajectory we know an uninhabitable world will be our fate in only a few more generations.

We can argue about the details, but the facts cannot be ignored. For example, the world is losing forests at a rate of about 120 square miles per day and as many as 3 million people, mostly in poor and developing countries, die each year from outdoor air pollution related to exhaust and emissions. Almost half that many are dying from indoor air pollution.

So it is not a matter of when our environmental destruction will impact our health, it is a question of when will it be a non-compatible threat? When will we reach the tipping point, beyond which we may not be able to return?

I liken our behavior to the smoker who says he will quit next week. At some point that is also the week he is diagnosed with a fatal illness. We have to change our habits before the earth develops its cancer.

Real Conversation on Safe Food and Water

With WK “Big Kenny” Alphin and Dr. Randy Wykoff, I am launching #Conversation2015, a look at the opportunities we have to make dramatic changes through compassion and caring. Read the introduction to the project here and the overview of safe food and water here. Then join the conversation on Twitter and Facebook: #Conversation2015

For many Americans it is a shock to realize there are still more than 2 billion people without access to clean water and 40% of the world population is without access to a toilet. The daily chore of securing clean water – clearly a necessity of life — can take up to eight hours a day and quite frankly be a life threatening endeavor in itself. As a result, over 3 million people a year are believed to die from water-related diseases.

Access to clean water, and the ability to keep it clean by not having it contaminated with human waste, industrial by-products, mining effluents, or other pollutants, is absolutely essential to improving health.

Even in the absence of significant famines, it is estimated that each year over half of all deaths of children under five are associated with malnutrition. This translates into almost 20,000 deaths per day.

As the world’s population grows, there will be a growing tension on the supply of food and water. Furthermore, regional disruptions in the food supply—from hurricanes, fires, earthquakes, or man-made disasters—will impact increasing numbers of people. For locations that are already without a supportive infrastructure, their communities are one natural disaster away from desolation of their community.

My global health organization, Hope Through Healing Hands, works with some excellent organizations addressing these issues. How can we all help?

 

 

Time to advance a new oversight framework for health IT

By former Sen. Bill Frist (R-Tenn.), MD

(The Hill; December 11)

Innovations in digital technology have changed the way we live our everyday lives, and we are finally, just now, seeing them change the way that we deliver health care and manage our own health.

Now new technology makes it possible for us to track and improve our health and wellness by logging our personal habits like physical activity, food intake, and sleep, as well as helping us keep track of important health information like medications and blood pressure. Americans are also using social networks for much more than socializing. Through online communities patients and caregivers are sharing their stories and advice, getting emotional support, and even logging and sharing side effects of specific treatments and interventions. In addition, price transparency tools are emerging to help the consumer-patient make better informed decisions about the quality and costs associated with many medical choices.

Given the pace of technology in every other field, it is embarrassing to report that we are just now seeing a significant penetration of online communication between doctors and patients. However, it is imperative to the efficient delivery of modern medical care. In addition to moving medicine into the 21st century with online portals and secure emailing, we are also seeing the rise of telehealth. Telehealth or connected health has been aided by the slow but eventual uptake of electronic health records by the nation’s physicians and hospitals. We can now access patient data and support on best practices at the point of care between physician visits. As we combine this type of health information access with genomic information, we move one step closer to truly personalized medicine.

However, new innovation is always met with the age-old problem of existing regulation. Laws are understandably written with existing technology in mind and without flexibility for an evolving and unforeseeable landscape. What Congress envisioned 40 years ago is simply no longer relevant. To support invention and innovation we need a flexible, risk-based oversight framework that protects patient safety and reduces regulatory duplication.

To address this need the Bipartisan Policy Center has engaged hundreds of stakeholders and experts to develop a set of principles and recommendations for a new oversight framework for digital technologies in health care. The BPC framework—reflecting agreement among leaders across every sector of health care—calls for higher risk health information technology (IT) to be subject to oversight via public-private partnerships promoting adherence to a set of voluntary consensus standards and patient safety reporting. This framework would better support rapid response, learning, and improvement. Advancing and implementing this framework was discussed during an event I kicked off at the Bipartisan Policy Center last week.

The good news is this is on the radar for Congress, the administration, and the private sector alike, with everyone agreeing we need a risk-based framework for health IT.
Just last week during BPC’s event, Representative Marsha Blackburn (R-TN) confirmed that an updated version of the Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act of 2013, which has 38 co-sponsors on both sides of the aisle, would be part of the 21st Century Cures package scheduled to emerge from the House Energy and Commerce Committee in January. Also last week, Sens. Michael Bennet (D-Colo.) and Orrin Hatch (R-Utah) introduced the Medical Electronic Data Technology Enhancement for Consumers’ Health (MEDTECH) Act, which provides greater certainty regarding regulatory expectations, limiting the Food and Drug Administration’s role related to low risk medical software and mobile apps in alignment with the BPC framework.

And the administration is also onboard with the release in April 2014 of the FDASIA Health IT Report: Proposed Strategies and Recommendations for a Risk-Based Framework, which reflects many of the principles and recommendations outlined in the BPC report.

With growing agreement among and action by Congress, the administration, and the private sector we are on the cusp of evolving a regulatory environment that would reward innovation, protect patient safety, create jobs, and improve health and health care in this country. But we cannot stop now.

We demand online and digital access 24 hours a day to most of the other information in our lives and employ digital technologies and devices to make frictionless our daily business and leisure activities. Why should something as important as our health be any different? Sure there are barriers and privacy considerations, but we can overcome them. We know how right now. So, it is time to move on bringing health information technology up to speed with the rest of our lives. No more excuses.

Frist was senator from Tennessee from 1995 to 2007. He was Senate Majority Leader from 2003 to 2007, and is currently senior fellow at the Bipartisan Policy Center.

This article originally ran online: http://thehill.com/opinion/op-ed/226680-time-to-advance-a-new-oversight-framework-for-health-it

Building Companies that Change Medicine

I am a partner at Cressey & Company, a health care focused private investment firm, where I serve as chairman of the company’s Distinguished Executives Council.  Yesterday, we announced the closing on a new fund that totals $615 million. Health care in America is changing so rapidly and I believe health-IT is an essential part of that. That’s why we are building high quality, value-driven companies that are centered on better care of the patient and prevention of disease.

It’s clear that government is not in a position to move as quickly as the market demands, but the innovation I’ve seen in private companies is astounding. Technology will change the face of medicine for the patient, the physician, and the payer, and we specialize in eliminating gaps in health care delivery so the patient sees better access and improved care.

It’s such an exciting time to watch to the health care industry change to deliver better care in better ways than ever before.

Read more about our news at:
Nashville Business Journal

November Update

The fall has been exceptionally busy around here with several international trips and speaking engagements, but I was able to be home for Thanksgiving and got to enjoy some of the beautiful autumn color that Middle Tennessee has to offer.

I hope you all had a happy Thanksgiving holiday. Here’s an update on some of what we’ve been up to.

Hope Through Healing Hands (Global Health)

We are very glad that some of the panic associated with the Ebola outbreak has calmed. Infections in the U.S. have been few and none of those healthcare workers who were infected here have succumbed to the disease.

But in Africa, the problem is still very real. Last month there was a panel at Vanderbilt University on U.S. leadership on Ebola in West Africa and at home. My notes from the event were published at Forbes. Now is the time to think carefully about what we are learning from this outbreak. Not only how do we best help and treat those sick with Ebola, but what can we learn about how our country responds to international health crises? What can this virus tell us about other hospital-acquired infections? What are containment best practices?

We must also remain aware that the countries battling the worst of Ebola are facing many other health challenges as well. The infrastructure questions for these health systems are complex and many. Foreign aid will still be needed after this outbreak is contained.

With foreign health systems at the front of mind, I had the opportunity to twice visit Cuba over the past six weeks. They were powerful trips. Cuba is a fascinating country, rich in culture and art despite severe and widespread poverty. Immediately after returning I got my first impressions down in a blog post. I was struck by some of the strengths of the primary care system—a system that in many ways reminded me of my father’s medical practice. But at the tertiary care level, the system falls apart to the detriment of the Cuban people. As we always find with international travel, Cuba yielded observations that will shape and inform thinking.

SCORE

Falling between the two trips to Cuba was one of my favorite dates all year: the annual SCORE Prize event. We awarded three $10,000 awards to individual schools and one $25,000 award to a school district for outstanding work with Tennessee’s students.

It is always an honor—and such fun!—to be a part of this night. Congratulations to Dresden Elementary School; Hillsboro Elementary/Middle School; Covington High; and Kingsport City Schools.

Also last month our friend Touch left for new horizons. Touch the Dog was auctioned off to benefit the Old Friends Senior Dog Sanctuary at the beginning of October. His new home is in South Carolina, but he’s sure to keep spreading his message of compassion, healing, and connection.

Domestic Health Reform

We’ve noted over the past several weeks the challenges that still lie before the VA. Congress wisely passed bipartisan legislation in July to bring greater accountability, transparency and patient choice to VA. Additionally, a new VA secretary, Robert McDonald, was appointed who will hopefully implement real change. As a former VA staff surgeon, I’ll be closely watching the progress.

But it’s not only our veterans who are faced with ongoing health challenges. The nation as a whole is struggling to reconcile our health goals and our realities. There have recently been great strides forward for the 86 million adults who have diabetes. The U.S. Preventive Services Task Force last month proposed new screening guidelines aimed at reaching a greater percentage of individuals at risk for diabetes. It’s a step in the right direction.

But really it’s up to all of us to take control of our health for ourselves and our communities. Yesterday we encouraged everyone to take a look at the Robert Wood Johnson Foundation County Health Rankings. You—like me—may be surprised and dismayed by what you learn. It’s time for us all to take action!

Finally, if you’re struggling with how insurance works, can we suggest the YouToons? The Kaiser Family Foundation’s series of animated videos is an amazing resource, and the latest short gets to the heart of the insurance structure. Maybe you’ll even recognize a voice there?

The Way Forward for Ebola

Thankfully—and appropriately—the panic surrounding Ebola in the United States has waned over the past weeks. But the calm doesn’t mean it’s time to move on, though the news cycle may have. All major crises can be teachable moments and now is the time to carefully consider our response to the Ebola outbreak and what we can learn to prevent these types of outbreaks in the future.

Last week I sat on a panel hosted by the Center for Strategic and International Studies (CSIS), the Vanderbilt Institute for Global Health, and Hope Through Healing Hands, the global health nonprofit for which I am founder and chairman.

I shared some notes from the discussion at Forbes.

2014 SCORE Prize Awards

Patricia Stokes, CEO of Urban League of Middle Tennessee; Spencer Beckman, Rise to the Challenge Winner; myself

Patricia Stokes, CEO of Urban League of Middle Tennessee; Spencer Beckman, Rise to the Challenge Winner; myself

Each year in late October I have the privilege of hosting the Annual SCORE Prize celebration. Every year just gets better and last night was no exception! We had a great time with school representatives from across the state and country music artist Dustin Lynch.

The SCORE Prize celebrates success in Tennessee’s schools, and this year we had much to celebrate! We awarded three $10,000 awards to individual schools and one $25,000 award to a school district for outstanding work with Tennessee’s students.

We also rewarded the students themselves. Students were invited to submit videos, essays, and creative writings that documented their experiences in classrooms and schools that have helped prepare them for their future through our Students Rise to the Challenge campaign. Last night we gave $250 college scholarships to three creative students for their entries.

The competition this year was fierce; I’m proud to say I think it gets tougher each year! Choosing the winners is the task of the SCORE Prize Selection Committee. They serve as crucial partners in planning and designing selection criteria for the SCORE Prize, and they give their time examining data and visiting schools and districts across the state. They’ve done great work this year, and we are grateful!

The 2014 winners are:

  • Dresden Elementary School
  • Hillsboro Elementary/Middle School
  • Covington High School
  • Kingsport City Schools (district award)

The Students Rise to the Challenge winners are:

  • Katie Workman, a third-grader at Foothills Elementary School of Maryville City Schools
  • Vincent Gould, a sixth-grader at Robinson Middle School of Kingsport City Schools
  • Spencer Beckman, a 12th-grader at Central Magnet School of the Rutherford County School District

You can get all the details on the 2014 SCORE Prize finalists and winners at the SCORE website, and be sure to look for upcoming case studies of best practices gleaned from these winners.

Congratulations again to SCORE, the winning schools, and all of the educators who are working so hard for excellence in Tennessee schools. I’m so proud of all you’ve accomplished, and I can’t wait to see what you do in this coming year!

 

Notes From the Road: A Big Picture Impression of Cuba

Two weeks ago, I was in Cuba as part of a healthcare delegation to learn more about the country as a whole and its healthcare system in particular on a “people-to-people” trip.

Cuba is a land of heterogeneity and chaos: an amalgam of cultures, colors, tastes, and textures. Wifi access there is severely limited, so I wasn’t able to blog from Havana. Since I returned, I’ve been focused on Ebola at home and in Africa, but I have had time to reflect a bit more on the trip.

I’ll dig into healthcare more soon, but first here is an overview of the biggest challenges for Cuba.

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Increasing social inequity. Twenty percent of Cubans live below the poverty line. It’s inconsistent with socialist values, but that’s the reality today. The socialist program is failing.

To be poor in Cuba is different from being poor in the rest of the world. This really struck me in comparison to what I’ve seen in Ethiopia, Kenya, South Sudan, and Bangladesh. The poor in Cuba don’t starve because everybody receives food rations—beans, rice and chicken—every week. The poor don’t die of curable diseases because the primary care system offers everyone free early treatment and prevention. Children are not forced to work.

But almost everybody works for the State, and their incomes are not high enough to match the free market prices, some of which is driven by the strengthening black market. As money starts to flow in Cuba, it aggravates the inequality and shows failure of the socialist system.

Low political participation. The decision-making process in Cuba is highly-centralized and far removed from the average person. The average Cuban feels like he has no voice in government. The people don’t feel like they can change things. They don’t elect their representatives. They’re just told what to do by the State. There’s declining political participation and people are very passive.

The State is overextended. Published numbers from the 1990s show that 95% of the labor force is employed by the State and 85% of the productive land is owned by the State. In the past, the State could support that burden with foreign money, but now the Soviet Union money has disappeared and the Venezuelan money has disappeared. There isn’t an influx of money with which to support the people. The Cuban government is looking mainly to Brazil to be their economic savior.

Too much bureaucracy. For the past decade, bureaucracy and government by very ineffective administrative control has been increasing. Leaders don’t have management techniques. Small businesses are buckling under bureaucratic regulations, and too many prohibitions stifle innovation.

Corruption. There seems to be corruption everywhere at every level with a general attitude of: “We need it; we take it.” For example, someone works at a restaurant not for pay, which is paltry, but so they can steal food and take it home to their family. Waitresses I talked to explained that salaries were miniscule, and patrons don’t tip. But by working in a restaurant, she can take a bit of food off the stove home to her family.

That kind of corruption is caused by unfilled consumption demands. People want more and there is no way to get it, so they take it. There’s no social contract. The whole concept of taxation is so foreign to them, because the federal government simply gives them everything. When that model begins to fall apart because of a lack of resources, the corruption and the stealing increases.

Media Policy. All media is party media—government media—of poor quality. For most Cubans, the internet does not exist. Access is severely restricted. Wifi is generally available only in big hotels, and then bandwidth is limited.  There’s been an explosion of cell phones in the last two years and people do have computers, but they can only download their news once a week from a memory stick.

Embargo with the United States. As the embargo approaches its 54th anniversary, it continues to have a major impact on nearly all aspects of Cuban life, and makes economic recovery and structural changes difficult. Even though there has been foreign investment, I believe things are not really going to improve in Cuba without a change from the United States.

Helping VA Do Better

(Military Times, October 15, 2014)

By Bill Frist

In his second inaugural address, President Lincoln articulated a clear principle to guide our nation’s commitment to military veterans. The goal, he said, should be “to care for him who shall have borne the battle and for his widow and his orphan.”

That sentiment still resonates a century and a half later, and the Veterans Affairs Department adopted Lincoln’s formulation as its motto. Yet as a string of VA scandals have come to light exposing shoddy patient care and bureaucratic malfeasance, it’s fair to ask, what happened to that mission?

Like all government-sponsored health care, VA is largely run by political appointees and bureaucrats, rather than professionals with specialized training in health care administration and management. The government approach to fixing a problem is usually to add a new regulation or yet another policy, when sometimes the cleaner solution would be to de-regulate and simplify.

Unfortunately, VA has suffered from this practice, resulting in an increase in middle managers and regulations that drive up costs, stifle innovation and make the system less responsive to the veterans it aims to serve.

The obstacles to timely care have been apparent to those working in the VA system for years. Indeed, I have experienced firsthand the challenges in that system; I served as a VA staff surgeon in Nashville, Tennessee, an experience that informed my approach to veterans’ issues when I later served in the Senate. I realize that VA simply must do better.

The patient scheduling scandal that arose in Phoenix this spring was simply the last straw. What made the revelations most appalling was the falsification of wait time records to ensure bonuses to administrators. That story suggests VA has lost sight of its true mission of service to veterans and their families.

In response, Congress wisely passed bipartisan legislation in July to bring greater accountability, transparency and patient choice to VA. Additionally, a new VA secretary, Robert McDonald, was appointed, with hopes that his fresh approach would lead the department in a new direction and institute some real change. Those were positive steps.

But those steps are only the beginning. The department has a long way to go both to restore the trust of our veterans and transform the current system into one that can deliver the timely, quality health care our veterans deserve.

So what next? The VA reform bill that passed earlier this year established a commission that will make independent recommendations that are due in early 2016. While this a worthy idea, we cannot continue to tell our veterans they will just have to wait.

It is essential that new ideas and fresh proposals, from outside VA and from all perspectives, be brought to the table for consideration. And we needed that to happen yesterday. Therefore, I am pleased to announce the formation of the Fixing Veterans Health Care policy taskforce, of which I will serve as one of five co-chairs.

My co-chairs on this taskforce, sponsored by the veterans advocacy organization Concerned Veterans for America, are Jim Marshall, a former Georgia congressman and Army Ranger, and two distinguished health care policy leaders — Dr. Mike Kussman, who served as the VA under secretary for health from 2007 to 2009, and Avik Roy, a health care scholar with the Manhattan Institute.

The goal of the taskforce is simple: Isolate existing challenges to veterans’ health care, identify systemic solutions, and propose concrete reforms to improve care delivery for our nation’s veterans. We will consult with the foremost health care management experts, former and current VA employees, members of Congress, and — most importantly — veterans and their families.

Through the submission portal on our taskforce website, we are actively seeking stories from veterans to get the most accurate story about what is going horribly, or well, in the VA system. We will then release a set of concrete recommendations in December that we hope will serve as the basis of reform legislation in the 114th Congress.

This taskforce will seek to think outside the box, challenge assumptions, and ask hard questions regarding the best possible way to deliver timely, efficient and effective care to our veterans. It seeks both short-term changes as well as systemic reform. And most importantly, the welfare of the veteran will be at the center of the coordinated patient care model we hope to recommend.

With politics, someone always disagrees, and we anticipate pushback from those who benefit from the status quo. But the status quo is unacceptable, and something has to change. It is on issues like these that we must employ bipartisan efforts and meet in the middle.

VA has changed before and they can do it again, which is why this taskforce is immensely important. Join us as we help the VA achieve the quality product our veterans deserve and we know they can deliver.

This article originally ran online: http://www.militarytimes.com/article/20141015/NEWS05/310150055/Opinion-Helping-VA-do-better