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Georgia Project Quarterly e-Newsletter
Volume 1, No. 4 (December 2007)
Welcome!
Welcome to the final 2007 issue of the Georgia Project Quarterly e-Newsletter. We offer this e-Newsletter as a way to keep you informed of our activities and progress in Georgia. In addition, since transformational leadership training is one of The Center’s key activities, we include in each issue a key principle, idea or passage from our book The Art of Transformation, co-authored by The Center's founder Newt Gingrich and CEO Nancy Desmond.
The basic strategy of the Georgia Project is to work collaboratively with transformational leaders to accelerate the creation and adoption of solutions, technologies and policies that drive system-wide transformation into a 21st Century Health System that saves lives and saves money for all Americans. Although we work actively in 39 states, Georgia serves as an implementation project where we identify and build models to replicate in other states. Our members and allies play key roles in the identification and development of the models that are transforming health and healthcare.
The Center's Georgia-based team
We welcome your feedback, ideas, questions and comments, as our goal is not just to inform and educate but also to learn from you. We hope you enjoy this edition of our Georgia e-Newsletter and wish you and your family a safe and happy New Year.
If you are reading this e-Newsletter from The Center's website, sign up to receive this and The Center's other e-Newsletters.
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The Healthy Georgia Diabetes and Obesity Project
Governor Sonny Perdue released a proclamation in November commending The Center for Health Transformation’s nationally-recognized Healthy Georgia Diabetes and Obesity Project. The proclamation was presented at a ceremony honoring the achievement of dozens of Georgia organizations whose work on the Project has led to significant strides toward improving the quality of care for those with diabetes and those at risk of developing the disease. The event was held at the UPS Corporate Office in Atlanta.
Left to right: Dr. Elizabeth Ofili, Senior Advisor for The Center; Newt Gingrich, Founder; Nancy Desmond, CEO; and Laura Linn, Director of The Center’s Georgia Project. Nancy holds a proclamation from Governor Sonny Perdue honoring The Center for its work on diabetes in Georgia.
As part of the Healthy Georgia Diabetes and Obesity Project, the collaboration launched one of the nation's largest pay-for-performance initiatives in the country by partnering with large employers, insurers and physicians to implement Bridges to Excellence in Georgia. The event celebrated the first annual distribution of quality incentives to participating physicians. As a result, the number of physicians recognized by NCQA as delivering best standards of diabetes care in Georgia has grown from only 5 to 149. More than 1200 patients with diabetes received care from the physicians who were recognized.
The organizations recognized for their participation in the Georgia Project included AT&T, Aetna, BlueCross BlueShield of Alabama, BlueCross BlueShield of Georgia, ChoicePoint, CIGNA, Columbus Research Foundation, GE, Georgia Ports Authority, GlaxoSmithKline, Gulf Stream, Humana, IBM, International Paper, Kaiser Permanente, Marriott International, Medical Association of Georgia, Morehouse School of Medicine, Novo Nordisk, Pfizer, members of the Savannah Business Group on Health, Southern Company, the State of Georgia, Synovus, The Institute for Wellness & Education, United Healthcare, UPS (hosting the event), WellStar Health System, St. Joseph's/Candler Medical Group and Xerox.
"It was a celebration of the accomplishments and participation in The Center's Healthy Georgia Diabetes and Obesity Initiative," said Laura Linn, Project Director for the Center for Health Transformation. We truly have a collaboration of public and private sector leaders dedicated to improving the treatment and outcomes for people with diabetes and to promoting early diagnosis and prevention of diabetes, including decreasing the prevalence of obesity."
An estimated 18 million Americans have diabetes, including almost 6 million who don't know it. Another 41 million are pre-diabetic, a condition that will likely progress to diabetes without appropriate preventive treatment. An additional concern is the increase in obesity: a major risk factor in developing diabetes.
Diabetes is a common, serious and costly disease in Georgia. Approximately 7% of the adult population in Georgia has diagnosed diabetes. For every two patients diagnosed with diabetes. another has not been diagnosed. The prevalence of Type 2 diabetes is increasing throughout Georgia, including children and adolescents. In 2000. diabetes was the 6th leading cause of death in Georgia, killing approximately 1500 Georgians. Diabetes can contribute to heart disease, stroke, blindness, kidney failure, amputations, and early death, particularly when best standards of care are not followed. In Georgia, the cost of diabetes due to medical care, lost productivity and premature death is over $4 billion per year.
"Transforming health and healthcare in America is foremost about saving lives," said former Speaker Newt Gingrich. "When it comes to diseases like diabetes, prevention and quality care are essential. These organizations have not only recognized this fact but they have also allocated precious resources to curb the growing obesity and diabetes epidemic in this country."
"Today's event is an opportunity for us to honor an outstanding group of leaders and the collaborative work they have done to help create a healthier Georgia," said Center for Health Transformation CEO Nancy Desmond. "While there is much work ahead of us, we thought it was important to take a moment to recognize the amazing progress made by these remarkable organizations."
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21st Century Healthy Communities Projects
The Columbus Project
The Medicare Diabetes Screening Project Engages the Senior Community in Columbus GA in the Drive to Fight Diabetes
As part of the Healthy Georgia Diabetes and Obesity Project, The Center has partnered in Columbus, GA with community leaders and two organizations – the Columbus Research Foundation and the Medicare Diabetes Screening Project (MDSP) – on programs that are changing the way diabetes is treated.
Dr. Stephen Leichter of the Columbus Research Foundation (CRF) is leading an aggressive drive in Columbus, GA in the working age population to “change the metabolic profile of the community” through an innovative workplace screening, information and referrals effort called The Columbus Project. To extend the reach to others at risk for diabetes – those people who are age 65 and older - The Center and the Columbus Project added a partnership with the MDSP to help find the more than 12,000 Columbus residents in Medicare who have undiagnosed diabetes or pre-diabetes.
Diabetes exerts a terrible toll on people ages 65 and older. Nationwide, it is estimated that as many as 17 million seniors in Medicare have undiagnosed diabetes or pre-diabetes. To address this problem and to promote diabetes screening, the MDSP was formed. It is a coalition of more than 20 government, professional and private sector organizations, co-chaired by the American Diabetes Association, the Healthcare Leadership Council, and Founding Charter Member Novo Nordisk Inc.
Together, leaders from these organizations have created a campaign to generate awareness and use of a new, free Medicare diabetes screening benefit. Efforts in Columbus, GA, along with the State of New Hampshire, are two pilot projects launched by the MDSP this summer to develop effective outreach and communication models to promote the benefit at the grassroots level – and to find the undiagnosed.
Led by Maurice Madden, the director of the MDSP in Georgia, along with the CRF staff, a tremendous amount of public awareness activities and grassroots organizing have been accomplished in a short period of time.
Left to right: Terry Womack (The Center), Chris McGowen (Novo Nordisk), Mayor Jim Wetherington (Mayor of Columbus), CAPT. Clara Cobb (Regional Health Administrator for the Dept of HHS), Dr. Steven Leichter (Clolumbus Research Foundation), Rep. Carolyn Hugley (Georgia State Representative), Mike Gaymon (President and CEO, Greater Columbus Georgia Chamber of Commerce), Dr. Richard Wild (Chief Medical Officer for CMS Atlanta)
Activities in Columbus, GA began officially on July 19th with a Civic Center rally and arrival of the Medicare Prevention and Wellness Tour Bus, an outreach service of the Centers for Medicare and Medicaid Services (CMS). This kickoff event was supported by newspaper and radio advertising that encouraged seniors in Medicare to ask their doctors about getting checked for diabetes. CMS has since designated the MDSP campaign in Columbus its “Prevention Challenge” project for the state of Georgia.
Over the course of the summer, MDSP’s Madden and CRF’s Dr. Leichter networked extensively with healthcare professionals, government officials, churches and other non-profit organizations, seniors and caregivers, to engage the community in efforts to reach seniors. For example, Mr. Madden hosted educational luncheons at the local chapters of the Veterans of Foreign Wars and the American Legion to encourage diabetes screening among senior participants, and engaged the local Area Agency on Agency in outreach efforts. To reach physicians, a dinner was held in September to reiterate the diabetes screening benefit in Medicare and to alert physicians to the public awareness messages of the MDSP campaign. Business leaders were reached through the Greater Muskogee Chamber of Commerce.
Two of MDSP’s biggest successes were recruiting and engaging the support of the faith-based community and the City Council and Mayor’s office. Rev. Dr. Johnny Flakes and Rev. Dr. Hal Brady – recognized in Columbus as leading members of the clergy – lent their names, photos and voices to a newspaper and radio advertising campaign that urged seniors to ask their doctors about getting checked for diabetes. Revs. Drs. Flakes and Brady urged their peers to address diabetes with their congregations. At services on Sunday, November 11, more than 15 churches distributed over 5,000 church bulletins on the Medicare screening benefit to parishioners and many clergy spoke about the issue from the pulpit. The church outreach effort will continue in coming months.
And on November 14th, which is recognized as World Diabetes Day, Columbus Mayor Jim Wetherington and City Councilor Jerry “Pops” Barnes, RN, along with other community leaders, came together at the request of the MDSP for a press conference that drew outstanding media coverage. Terry Womack of The Center took part in the press conference which served to cap a month’s worth of activities designed to raise awareness of the need for diabetes screening among seniors ages 65 and older.
A national partner of the MDSP, Vision Service Plan (VSP), will join the effort in Columbus in 2008 with risk assessment screenings. VSP optometrists, in addition to checking patients for diabetic retinopathy will additionally check for high blood pressure, abnormal blood sugar, and body mass index. Patrons found to be at potential risk for diabetes or other metabolic conditions will be referred to a primary care physician.
Other events that are in the plans for 2008 include outreach to the senior community through learning sessions at senior centers, churches and community health fairs; informational sessions with nurses, physician office managers and assistants; outreach to pharmacists; and potential collaboration with the Urban League.
The Center is proud to be a partner with the MDSP in Columbus, GA and looks forward to the continuation of work in Columbus to create a 21st century healthy community.
deCODE genetics Joins the Center’s Collaboration of Leaders
CHT is pleased to announce the addition of deCODE genetics to our collaboration of leaders participating in the Georgia Project. deCODE genetics is supporting the Columbus Research Foundation’s program to assess “Metabolic Syndrome” and alter the metabolic status of the working-age population in the Columbus, GA community. deCODE will be working with the staff of the Columbus Research Foundation and the community to study the prevalence and association of genetic risk for type 2 diabetes and heart attack with individuals who have metabolic syndrome or conditions associated with metabolic syndrome.
The inclusion of the genetic risk tests supports the Columbus Project goals:
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Improving the knowledge and care of area physicians for patients with metabolic syndrome and its associated disorders, based on the national guidelines for diabetes care of the National Committee for Quality Assurance (NCQA);
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Enhancing the health awareness and consumer behaviors of working adults with metabolic syndrome, diabetes, hypertension, or hyperlipidemia, both in terms of their own health habits and in terms of their expectations of care from their health providers;
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Conducting a major health assessment of randomly selected members of the working population with metabolic syndrome to determine the characteristics and prevalence of cardiovascular risk factors in this group of people, and to assess whether the interventions improve the health status of this group.
Gainesville Georgia
Gainesville Georgia, another of the participants in the Center’s 21st Century Healthy Community Project, led by Mimi Collins and the Health Committee of the Greater Hall Chamber of Commerce, held an interactive health and wellness expo on October 24. About 1,200 people took the time to get a little smarter about their health.
Following a kickoff breakfast featuring a presentation by former NBA star and Center for Health Transformation advisor Dominique Wilkins, crowds of visitors wandered through more than 70 exhibit booths, many of which offered free health screenings and other services. The expo was the first event of several planned to increase awareness and improve the health of the community. Mimi Collins recognized the fall 2006 health summit presentation by Newt and the support of Georgia Project Director Laura Linn and CEO Nancy Desmond as critical to the Gainesville 21st Century Healthy Community Project.
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The Center Provides Solutions to Senate Committee on Health Transformation
Last month project directors David Merritt and Wayne Oliver made presentations on solutions to help transform Georgia’s health care system. Mr. Merritt focused on providing solutions for the uninsured and Mr. Oliver focused on electronic prescribing. Senator Judson Hill serves as the chairman of the committee which has spent the better part of two years holding hearings and listening to health policy experts and policy thought leaders. The committee will issue a report later this month and make specific recommendations to implement transformational solutions for Georgia’s healthcare system.
Mr. Merritt urged Senators to think boldly: “The same Census Bureau report shows that there are 15 million Americans who are uninsured but earn more than $50,000 a year. Many have chosen not to purchase health insurance. There are approximately 15 million other Americans who do not have health insurance because they have moved, lost a job, or their employer does not offer coverage anymore. Most of these folks ultimately get coverage, but if you were to walk in their shoes—or anyone without health insurance—it is a sad situation. They live in fear every day. Fear that their child will get sick but cannot see a doctor. Fear that their spouse will have a serious accident that prevents them from working. And the constant fear that they are one step away from medical bankruptcy.”
Mr. Merritt continued, “The same goes for people who are denied coverage or who cannot afford insurance but earn too much to qualify for a public program. As a result, they have virtually no access to a primary care doctor, will likely be sicker, and may die needlessly. The Institute of Medicine estimates that the lack of health insurance actually kills 18,000 Americans every year. Right here in Georgia, the crisis of the uninsured affects every Georgian, even those who are insured. Every citizen who has health insurance pays a hidden tax to cover the cost of delivering care to the uninsured. After all people without insurance still need and ultimately do get medical care, but it is often in an emergency department, the most expensive healthcare setting one can find. The cost of this care is passed along to those who do have insurance in the form of higher insurance premiums. Ken Thorpe of Emory University estimates that in 2010 these higher premiums for those with insurance will total $1.8 billion in Georgia—more than $1200 for every insured family in Georgia.
Mr. Merritt also discussed the Center’s four boxes of health model of transformation. Mr. Merritt said “First, we must focus on health first—then healthcare—and individuals must take an active role in becoming healthier. Second, we must create a culture of health that encourages more responsible individual choices. We can do this by redesigning how public and private institutions influence individual behavior, and nowhere is this needed more than in public education. Third, once someone enters the healthcare system, we must dramatically improve and modernize the way they receive care. Lastly, we must radically change the way we finance health insurance. Between individuals and their doctors are mountains of burdensome regulations, hoards of middlemen, and red tape as far as the eye can see. In no other sector of society do we accept such a convoluted approach to buying a product or service. Putting consumers squarely in control is essential.
Mr. Merritt urged Senators to assist in “building what we at the Center for Health Transformation call a 21st Century Intelligent Health System, embracing this level of change is an absolute necessity.” Specifically, he indicated that legislators should:
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Ensure that state law gives private health plans, including those that participate in Georgia Medicaid and the state employees’ health insurance program, the latitude to design insurance products to encourage and reward individual healthy behaviors.
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Conduct a full-scale review of all state education law to ensure that employers and local officials have the freedom to try new approaches to promote health, wellness, and nutrition.
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Introduce new provider payment models into Georgia Medicaid and the state employees’ health insurance program, that move from a transaction-based reimbursement model to an outcomes-based model.
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Make available all claims data, as well as performance and price information, for all providers, suppliers, and health insurers that do business with the state of Georgia.
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Enact cross-state purchasing agreements with other states so that Georgians can purchase licensed health insurance policies outside of Georgia.
David Merritt said that Speaker Gingrich may have put it best when he said, “These kinds of changes will break a lot of china.” They represent a serious effort that can improve quality, reduce healthcare costs, and expand insurance coverage—things that the current system is incapable of doing. Today’s system will always result in rising costs, too many without insurance, poor quality, and an unhealthy population. Any plan to cover the uninsured that builds upon such a dysfunctional system simply throws good money after bad. We can do better.
With real change, through the ideas outlined here today, we will improve individual health, modernize the delivery and administration of care, and expand insurance to every Georgian and every American. Our country, our states, and our citizens deserve nothing less.
For a complete text of David Merritt’s testimony, click here.
Mr. Oliver was invited to appear to update the committee on electronic prescribing. Earlier this year, The Center cosponsored a stakeholder meeting on e-prescribing in Georgia. Speaker Gingrich attended and challenged the attendees to make Georgia the first state in the nation with 100 percent e-prescribing. After the summit, The Center formed a collaborative working group to accelerate the adoption of e-prescribing in Georgia. Mr. Oliver reported that the group has met several times in 2007 and is working toward solutions for 2008. Members of the working group include:
Mr. Oliver suggested that the State of Georgia should invest in health information technology. “More than 1.5 million Americans are injured annually by preventable medication errors,” Mr. Oliver said. “That is the equivalent of over 200 Georgians killed and more than 45,000 injured each year due to medication errors. To understand those figures, consider this: Imagine 6 school buses crashing and injuring all of the children on board … everyday for an entire school year. State government would step in, close all schools, suspend school bus service statewide indefinitely and launch an intensive investigation. We would not restore bus service until we were assured of 100 percent safety. Well, that’s exactly what is happening every day here in Georgia from preventable medication errors,” said Mr. Oliver. He suggested that the State of Georgia is paying millions of dollars in unnecessary but costly encounters for state employees, retirees, school teachers as well as Medicaid patients injured as a result of preventable medication errors. Unnecessary hospitalizations and preventable deaths should not be acceptable in the 21st century.
For more specific information on the Georgia e-prescribing project, click here.
Mr. Oliver suggested that the legislature can have a dramatic impact on adoption of advanced technology which will improve outcomes and reduce costs. “For example, state programs should develop incentives for physicians and pharmacies (SHBP, Medicaid) to invest in e-prescribing technologies,” said Mr. Oliver. “We strongly believe in the rapid infusion of interoperable electronic systems by healthcare professionals and health facilities in vital. We should do everything we can to create opportunities for physicians to implement electronic medical systems including e-prescribing. We should implement transformational solutions like lowering professional liability premiums for providers who use e-prescribing and EMR technologies. We should also ask the budget experts to examine the savings associated with e-prescribing for Medicaid and the State Health Benefit Plan.
In the past, The Center has urged policymakers to think boldly in terms of tax policy for technology investments. “We believe in incentives as a strategy to accelerate the adoption of HIT,” said Mr. Oliver. “Georgia’s tax policy would certainly be an effective tool to assist in rapid development of systems designed to saves lives and saves money.”
For a copy of Mr. Oliver’s presentation, click here.
Other CHT Resources:
Over the past two years, Center for Health Transformation founder Newt Gingrich, policy directors Jim Frogue, David Merritt and Wayne Oliver and Senior Fellow Ron Bachman have appeared before the committee.
To view those presentations, please visit one of the following:
Senior Fellow Ron Bachman: "Georgia as an HSA State"
Project Director Jim Frogue: "Georgia Can Improve Quality and Lower Healthcare Costs"
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From The Art of Transformation: Principles of Transformational Communication
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Win the moral argument
Margaret Thatcher had a great line: first you win the argument, then you win the vote. But don’t assume you’ll win the vote before you win the argument.
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A key part of winning the argument is defining the argument. Change happens at many levels, but the first is changing the language. This is what Ronald Reagan understood so brilliantly. He was in a very small league of presidential and national leaders who have been able, by the sheer power of their words, to change reality.
Reagan understood that to win the argument at its most profound level, you have to have clarity, simplicity, cheerfulness, and brute repetition. Reagan didn’t mind saying the same thing for twenty years. He had first said, “Tear down this wall” in 1967 as governor. He was just repeating it in 1987.
Winning the argument in America starts with making the moral case. As Alexis de Tocqueville observed in his classic, Democracy in America, “America is great because America is good.”
Our first goal when trying to communicate the case for transformational change to the public is to win the moral argument. For example, the title of our book about health transformation is Saving Lives and Saving Money. We always talk about saving lives and saving money in that order, because we have to make the moral case first and the financial case second.
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