Health Affairs Pathways

This is a special publication of the first season of the new Health Affairs podcast, Research and Justice For All. The first season, "Private Sector Solutions," is sponsored by CVS Health. The six-episode season will publish Wednesdays.

Guest: Thomas Sequist, Chief Medical Officer at Massachusetts General Brigham

In the first episode of Research and Justice For All, CVS Health’s Sree Chaguturu and Joneigh Khaldun interview Thomas Sequist from Massachusetts General Brigham on the important role of health and hospital systems in driving health equity in the US.

This season is sponsored by CVS Health.

Related Links:  

• Beyond Research, Taking Action Against Racism (Health Affairs Forefront)  
• United Against Racism 2-Year Anniversary: A Reflection from Mass General Brigham’s Chief Community Health & Health Equity Officer (Massachusetts General Brigham)  
• Mass General Community Health (Massachusetts General Hospital)

Explore the CVS Health-sponsored Health Affairs Forefront short series, “Private Sector Solutions for Health Equity.”

Health Affairs' Jeff Byers interviews Tracy Fasolino about her experience with creating the podcast series No One Gets Out of Here Alive for the Health Affairs Podcast Fellowship.

In the final episode of No One Gets Out of Here Alive, Clemson University’s Tracy Fasolino addresses the four challenges facing palliative care and hospice services and highlights some of the legislative bills that may fill the needs for patients and caregivers dealing with serious illness. 

Guests on this episode include Edo Banach, Dr. Betty Ferrell from City of Hope, Dr. Wayne Hollinger, Mr. Pat Coyne from Medical University of South Carolina, and Ginger Marshal, CEO of Hospice & Palliative Nurses Association. 

No One Gets Out of Here Alive was produced by Tracy Fasolino for Health Affairs Podcast Fellowship Program.

Music by Elias Workman.

Related Links:

• The Hospice Paradox: How Medicare Fails Americans At The End Of Life (Health Affairs Forefront)
• A National Strategy For Palliative Care (Health Affairs)
• The Hidden Curriculum Of Hospice: Die Fast, Not Slow (Health Affairs Narrative Matters)
• Understanding The Use Of Medicare Procedure Codes For Advance Care Planning: A National Qualitative Study (Health Affairs)

Welcome back to No One Gets Out of Here Alive, where we spend time talking about various legislation that impacts delivery of palliative care and hospice services right now. In this episode, we hear from one family as they share their story in dealing with the serious illness of chronic obstructive pulmonary disease. 

Host Tracy Fasolino of Clemson University presents four challenges facing palliative care and hospice services right now. 

No One Gets Out of Here Alive was produced by Tracy Fasolino for Health Affairs Podcast Fellowship Program.
 
Music by Elias Workman. 

This episode is dedicated to Al & Wendy for their amazing bravery and exemplary love. 

Related Links:

• Live hospice discharge: Experiences of families, and hospice staff (National Library of Medicine)
• Live discharge from hospice for people living with dementia isn't “graduating”—It's getting expelled (Journal of the American Geriatrics Society)
• Subjects Sentenced in $150 Million Hospice Fraud Case (Compliance Resource Center)
• The Forgotten and Misdiagnosed Care Transition: Live Discharge From Hospice Care (National Library of Medicine)

Welcome to No One Gets Out of Here Alive, the fifth series from Health Affairs Pathways. In this series, Clemson University's Tracy Fasolino unpacks some of the legislative and policy issues associated with palliative care and hospice services through the lens of a nurse. 
 
To start, Tracy peers into the past and tells the history of hospice legislation and the evolution of palliative care. She highlights the key players in the creation of the hospice benefit and shares insights on the growth of palliative care in the US.

Guests on this episode include Edo Banach, Dr. Betty Ferrell from City of Hope, and Dr. Wayne Hollinger.

Music by Elias Workman.

Related Links:

• Dr. Elisabeth Kübler-Ross Interview
• President Nixon Signs the National Cancer Act (Richard Nixon Foundation)
• National Hospice Study: Patient and Facility Data, [1980-1983]
• Policy and the Reformation of Hospice (Journal of Hospice & Palliative Nursing)

Health Affairs' Jeff Byers interviews Dr. Michael Shen about his experience with creating the podcast series A Disproportionate Share for the Health Affairs Podcast Fellowship.

Related Links:

• A Disproportion Share - Episode 1
• A Disproportion Share - Episode 2

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores the role of safety net hospitals in caring for America's vulnerable populations.

In the final episode, Shen discusses why supplemental payments for safety net hospitals might be at risk and look at policy approach that could bolster the safety net. He interviews individuals from NYC Health + Hospitals, America's Essential Hospitals, and University of Pennsylvania.

Related Links:

• Michael Shen
• Disproportionate Share Hospital (Centers for Medicare & Medicaid Services)
• Variation and Changes in the Targeting of Medicaid Disproportionate Share Hospital Payments (Health Affairs)
• Annual Analysis of Disproportionate Share Hospital Allotment to States - 2022 (MACPAC)
• For Disproportionate-Share Hospitals, Taxes and Fees Curtail Medicaid Payments (Health Affairs)

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores the role of safety net hospitals in caring for America's vulnerable populations.

In this episode, Shen discusses how we pay for essential care for low income patients delivered through our safety net hospitals and the complex patchwork of supplemental payments for such care. He interviews individuals from America's Essential Hospitals and NYC Health + Hospitals to explain cost-shifting, uncompensated care, payer mixes, cash on-hand, and more.

Related Links:

• Michael Shen
• What Types of Hospitals Form the Safety Net? (Health Affairs)
• Podcast: Understanding Private Equity Investment in Hospitals (A Health Podyssey)
• Can Safety-Net Hospital Systems Redesign Themselves To Achieve Financial Viability? (Health Affairs Forefront)
• Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare's Value-Based Purchasing (Health Affairs)

Welcome back to Health Affairs Pathways, the podcast fellowship program from Health Affairs.

In 2023, we have two exciting seasons for listeners, one on safety net hospitals and another on palliative and hospice care.

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores safety net hospitals and how we pay for them.

In this first episode, Shen looks at the closure of Hahnemann University Hospital, a large urban hospital affiliated with a major academic medical center, to ask how safety net hospitals sustain themselves on thin financial margins. He shares what safety net hospitals are and their role in caring for America's vulnerable populations.

Related Links:

• Michael Shen
• Graduate Medical Education Should Not Be A Commodity (Health Affairs)
• Podcast: Graduate Medical Education Should Not Be A Commodity (Health Affairs Narrative Matters)
• The Death of Hahnemann Hospital (The New Yorker)
• To Protect America's Safety-Net Hospitals, Establish a New Federal Designation (Health Affairs Forefront)

In the fourth and final episode of The Earth Disease, journalist Jared Downing explores the carrots and sticks that the federal government can use to curb climate change.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Dr. Ashish Jha, Howard Frumkin from the University of Washington School of Public Health, and Arsenio Mataka from the Office of Climate Change and Health Equity at the Department of Health and Human Services.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• Department of Health and Human Services FY 2021 Budget in Brief (HHS)
• HHS Climate Adaption Plan - 2014 (HHS)
• Low Income Home Energy Assistance Program (Office of Community Services)

Music produced by Seth Kennedy.

In the third episode of The Earth Disease, journalist Jared Downing discusses how social determinants of health programs intersect with climate and health policy.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests in this episode include Aaron Bernstein from the Harvard T.H. Chan School of Public Health, Megan Sandel from Boston Medical Center, Adam Abdul Musawir from Good Food Markets, and Gary Cohen from Healthcare Without Harm.

Works Cited:

• Boston Neighborhoods Impacted By Urban Heat (The Scope Boston)
• A City Divided In Life And Death (The Margins)
• Health Spending In Most OECD Countries Rises, With the US Far Outstripping All Other (OECD Health Data)

Music produced by Seth Kennedy.

The health care industry is among the most carbon-intensive service sectors in the industrialized world. It is responsible for 4.4–4.6 percent of worldwide greenhouse gas emissions and similar fractions of toxic air pollutants, largely stemming from fossil fuel combustion.

In the second episode of The Earth Disease, journalist Jared Downing explores ways that the health care industry is working to curb its carbon footprint.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Dr. Ashish Jha, Bob Biggio from Boston Medical Center, Jeff Thompson formerly from the Gundersen Health System.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic (Health Affairs)
• Health Care Pollution and Public Health Damage In The United States: An Update (Health Affairs)
• Sources of Greenhouse Gas Emissions (Environmental Protection Agency)
• Budget of the United States Government

Music produced by Seth Kennedy.

Health Affairs Pathways explores the avenues and alleyways of the health care system through a variety of storytelling – from investigative journalism and health policy explainers to long-form interviews.

Unique series are created by fellows at the Health Affairs Podcast Fellowship Program, designed to support early to mid-stage professionals pursue an audio project, tell a unique health care story, and highlight voices that may not be heard otherwise.

Our third and final series for the 2021 cohort, The Earth Disease, is from Jared Downing, a journalist based in New York City. In this series, Jared Downing explores the intersection of climate change and health policy.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Ashish Jha, Aaron Bernstein from the Harvard T.H. Chan School of Public Health, Mariel Fonteyn from Americares, and Ed Gerber from the Lestonnac Free Clinic.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• Climate Change (World Health Organization)
• Spreading Like Wildfire: The Rising Threat of Extraordinary Landscape Fires (United Nations Environment Programme)
• It's Not Your Imagination. Allergy Season Gets Worse Each Year (Vox)
• Record-breaking Temperatures Have Been Reported In the Northeast, And Some Cities Could Feel As High as 110 Degrees Fahrenheit (Insider)
• Mental Health and Stress-Related Disorders (Centers for Disease Control and Prevention)
• Understanding Lyme and Other Tickborne Diseases (CDC)

Music produced by Seth Kennedy.

On the final episode of While We Wait, Avni Kulkarni and Sania Ali explore emergency psychiatric assessment, treatment & healing - or emPATH - units, and how they could re-imagine care emergency psychiatric treatment delivery.

The featured guest on this episode is Scott Zeller, formerly from the American Association for Emergency Psychiatry and currently the vice president of Acute Psychiatry at Vituity.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Effects of a Dedicated Regional Psychiatric Emergency Service on Boarding of Psychiatric Patients in Area Emergency Departments (NCBI)
• emPATH Units as a Solution for ED Psychiatric Patient Boarding (Psychiatry Advisor)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains information on excessive use of police force and the death of Elijah McClain.

The US mental health care system is facing an emergency. How do we respond?

In the penultimate episode of While We Wait, Sania Ali and Avni Kulkarni explore different models for crisis response and first responders, including law enforcement, EMTs, and social workers.

Guests on this episode include Thom Dunn from the University of Northern Colorado and Anthony Hall from the DC Department of Behavioral Health.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

How do we translate policy solutions into practice? Avni Kulkarni and Sania Ali learn about the next generation of mental health policy: the certified behavioral health clinic (CCBHC).

CCBHCs are one-stop shops for integrated mental health care that are tailoring treatment to fit you rather than fitting yourself into treatment.

Sania and Avni speak with two CCBHC executives hailing from two very different parts of the country: New York City and Nowata, Oklahoma.

Guests on this episode include Yaberci Perez-Cubillan from Acacia Network and Josh Cantwell from Grand Lake Mental Health Center.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• The National Council for Mental Wellbeing's Certified Community Behavioral Health Clinic Success Center

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

Integrated care is eliminating the goose chase for mental health services. On today's episode of While We Wait, Sania Ali and Avni Kulkarni interview two members of the Behavioral Health Integration (BHI) Task Force about the current state of our mental health care system and policy solutions.

The interview points to a promising opportunity to coordinate mental health services with the foundation of health care services: primary care.

Guests on this episode include Kenna Chic and Marilyn Serafini from the Bipartisan Policy Center.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Policies To Improve Implementation And Sustainability Of Behavioral Health Integration (Health Affairs Forefront)
• Tackling America's Mental Health and Addiction Crisis Through Primary Care Integration (Bipartisan Policy Center)
• Access To Mental Health Care And Incarceration (Mental Health America)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains outdated and potentially offensive language to describe mental illness.

While We Wait co-hosts Avni Kulkarni and Sania Ali step outside the hospital and dive headfirst into the archives to learn about a seismic shift in mental health policy that’s left the health care system scrambling to fill the cracks for decades. They examine words like “parity,” “deinstitutionalization,” and “non-quantitative treatment limits.”

Listen as Sania and Avni go back in time to make sense of it all and trace the roots of the mental health boarding crisis.

The featured guest on this episode is Andrew Sperling, former director of legislative advocacy from the National Alliance of Mental Illness and current senior director of government affairs at Intra-Cellular Therapies.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Mental Health Policy: A Complex History (Health Affairs)
• The Kennedy Forum
• 25th Rosalynn Carter Georgia Mental Health Forum (The Carter Center)

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

DISCLAIMER: This episode contains information about suicide. If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.

In today’s episode, Avni Kulkarni and Sania Ali head to the emergency department (ED) to learn how our nation’s safety net is struggling to keep up with the increasing demand for emergency psychiatric treatment. They learn about the boarding crisis through the lens of a clinician discussing how they decide which patients need inpatient admission and what tools they can use to treat mental health crises.

Guests on this episode include Shilpa Patel and Meghan Schott from Children's National Hospital.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11 (Health Affairs)
• Psychiatric Boarding In US EDs: A Multifactorial Problem That Requires Multidisciplinary Solutions (Center for Health Care Quality) 
• Computerized Adaptive Screener May Help Identify Youth At Risk For Suicide (National Institutes of Health)
• IMPACT DC Asthma Clinic
• National Alliance on Mental Illness

Welcome to While We Wait, the second series from Health Affairs Pathways. In this series, Sania Ali and Avni Kulkarni explore the mental health boarding crisis.

To start, Avni and Sania introduce you to the story of Karin Broadhurst and her son who waited for 36 days in the hospital for psychiatric treatment in Boston.

Long delays in care are commonplace for mental health patients who arrive in the emergency department (ED). Rather than a safety net, the ED can be a place with no progression in treatment where patients wait for change. Why? Because a mental health emergency can be an emergency that the ED isn’t ready for.

The Mental Health Boarding Crisis refers to the long-standing, nationwide problem of holding patients for hours, days, or even weeks in emergency departments and other observational settings because there are no available inpatient psychiatric beds in the hospital.

Guests on this episode include Karin Broadhurst, Dr. Patricia Ibeziako from Boston Children's Hospital, and Massachusetts State Senator Cindy Friedman.

While We Wait was produced by Sania Ali and Avni Kulkarni for Health Affairs.

Theme music by Tommy Scanlon.

Related Links:

• 'This Is A Crisis': Mom Whose Son Has Boarded 33 Days For Psych Bed Calls For State Action (WBUR)
• A Plan To Reduce Emergency Room 'Boarding' Of Psychiatric Patients (Health Affairs)
• Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During COVID-19 Pandemic - United States, January 1-October 17, 2020 (Centers For Disease Control and Prevention)
• Roadmap for Behavioral Health Reform (Commonwealth of Massachusetts)
• National Alliance on Mental Illness

If you or a loved one is thinking about suicide, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255) or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. You can also call 911.