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10IHCS2009

NDHilary Doe

CEBGracye Cheng

DCHC

Rober Nelb

NEBClayon Ferrara

Frank LinFay Pappas

Melanie Wrigh

Yunwen Zhang

TRICNwARI

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Copyrigh 2009 by he Franklin and Eleanor Roosevel Insiue.All righs reserved.

The opinions and saemens expressed herein are he sole view o he auhors and dono reec he views o he naional organizaion, is chapers, or afliaes.

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This series was made possibleby he generosiy o

Mr. Sephan Loewenheil.

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E, he Roosevel Insiue Campus Nework adoped Think Im-pac, a model ha re-emphasized our organizaions ounding goals o lookingo young people or ideas and acion, win orces necessary in he pursui ochange.

The ideas you will read abou in his years rs 10 Ideas series are he resulo he admirable creaiviy, hard work, and scholarship o Roosevelers. Thesepublicaionson Deense and Diplomacy, Economic Developmen, Educaion,Energy & he Environmen, Equal Jusice, and Healhare also a esamen ohese auhors engagemen wih he world. In environmens ha can be insular,Roosevelers show a willingness o look ouwards, o hink criically abou prob-lems on a local, sae, and naional level.

Bu, o his end, hese publicaions should only serve as a saring poin o agreaer process. Roosevelers mus be willing o ac in he communiies wherehese ideas can mos eec posiive change. For conceps ha you nd inspir-ing, we hope ha you are moivaed o leverage hem or he bene o your owncampus, ciy or sae, and ha you seek ou channels and movemens hrough

which o bring hese ideas o ruiion. And, in insances where you disagree,we hope ha you are challenged o see how you migh improve on or adap anidea.

Gracye ChengChair o he Naional Ediorial Board

Letter from the Editorp

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TRI Campus Nework was ounded on he premise hasudens have grea ideas, and in his journal, I hink we ound some. Wih somany people alking abou healh care reorm oday, new ideas migh seem hardo nd, bu our ellows coninue o surprise us wih heir creaiviy and innova-ion.

In paricular, hese ideas are innovaive in he way ha only sudens can be.Alhough we did no dicae any specic heme or his journal, all o he ideasseem o oer a new way o using echnology o address long-sanding challengeso he healh care sysem. I makes sense ha he generaion ha grew up wihhe inerne and smar phones would be among he rs o hink abou howhese ools can be used o creae a more sreamlined, mobile, and personalizedhealh care sysem. Unorunaely, sudens oday have no been asked enougho share heir grea ideas - we hope o correc ha error in hese pages and inour acions every day as Roosevelers.

Perhaps he mos exciing hing abou suden ideas and abou his journal is hahese ideas are only he beginning o wha we can do. You can expec o hear

much more rom hese sudens in he uure.

Rober NelbLead Sraegis or Healh Care

Strategists Note P

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Using Old TV Bandwidth

To Expand Rural TelehealthDavid Silver, Universiy o Colorado - Boulder

Develop the bandwidth le unused aer the switch to digital television to pro-vide ast internet access or telehealth programs in rural areas.

Rural communiies ace signican social and economic barriers o receiving qualiyhealhcare. Fieen percen o people in rural areas are below he ederal povery levelcompared o 12 percen o urban residens. Rural regions are requenly designaed asHealh Proessional Shorage Areas (HPSAs). For example, eigh Colorado counies haveonly one ull-ime primary care physician our o which are no acceping new Medicaidpaiens. Six addiional counies lack even a ull-ime primary care physician, and one

rural couny has no physician.

Home elehealh he use oremoe monioring o paiensblood pressure, glucose levels,and oher paien inormaion inhe elecronic sysem allowsrural access o more cenral-ized healh care proessionals

who can anicipae and prevenavoidable problems. A sudycompleed by he VeeransAssociaion ound ha homeelehealh reduced he averagenumber o days hospialized by25% and cu overall hospializa-ions by 19%.

A major barrier o elehealh inrural areas has been he lack o access o high-speed inerne. Telecommunicaions com-panies ail o wire low-populaion densiy regions or inerne because high inrasrucurecoss and low usage yield minimal reurns. Bu he swich o digial elevision (DTV) couldprovide high-speed inerne access along wih is many healh and communiy benes o rural communiies on he waves ha elevision broadcasers no longer use. Wih asimple adaper, communiies will be able o access he inerne wherever hey have acable TV. Telecommunicaions companies currenly deliver inerne on waves idenicalo hose ha elevision broadcasers use, bu a a higher requency. The requency o

hese waves make hem much less ecien o send over long disances, as he inorma-ion on he waves is easily disored. Because o is lower requency, elevision specrumbroadcass can cover our imes he area o higher-requency signals wih higher speedsand qualiy o service. On November 4, 2008, he FCC voed or he elevision spec-rum o be unlicensed aer he swichover o digial elevision in 2009. Google, Inel,and Microso are currenly working on devices ha harness he elevision specrum or

Key FactsBroadban d delivery reaches only 31% o herural populaion compared o 50% in urbanand suburban areas, bu virually all Americanshave access o elevision.

Rural wireless neworks ransmiting in he TV

band can cover our (4) imes he area, and a ahigher qualiy o service, han a nework rans-miting in curren unlicensed bands.A 2009 VA sudy ound a 25% reducion in heaverage number o days hospialized and a 19%reducion in hospializaions or paiens usinghome elehealh.

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broadband, commonly reerred o as whie space. The greaes successes have come ingeographic locaions wih ew preexising elevision saions, i.e. rural areas. Rural healh-care providers and more generally, rural communiies should give grea consideraiono he use o his new echnological resource. High-speed inerne access is imperaiveor he developmen o elehealh, as demonsraed by he Colorado Telehealh Ne-works roughly $11-million invesmen or wiring rural healh clinics and criical access hos-pials or broadband. However, his invesmen is no enough o ully implemen homeelehealh sraegies ransporaion issues o healh clinics and hospials sill remain aproblem or many rural residens.

Tha rural Americans own signicanly ewer compuers per capia han heir couner-pars poses a challenge o implemening his sraegy. However, Federal programs arealready in place ha subsidize compuer purchases in rural areas. Congress should looko hese programs o provide home elehealh paiens wih compuers.

Next Steps

Congress should und a granprogram o help rural provid-ers purchase adapers so aso use he TV cables ha heyalready have o creae iner-acive elehealh porals. Thisprogram could be unded and

incorporaed ino he exisingrural healh cener program.

Talking PointsBroadband is now a uiliy comparable o elec-riciy, phone lines, and waer. I is vial o no onlyhealh oucomes, bu educaional, economic andcommuniy developmen as well.Telehealh echnology promises o increase pre-venive care measures hrough home elehealhand collaboraion wih cenralized healhcare

specialiss.The swich o DTV will allow ciizen access high-speed inerne wherever here are TV cables.

Brennan, D. M., B. E. Holz, N. R. Chumbler, R. Kobb, and T. Rabinowiz. Visioning echnology or he uure o elehealh. Telemedicine and

e-Healh 14, 9 (November 2008): 982-985.

Colorado Healh Insiue. Daa. Rerieved April 7, 2009, rom htp://daacener.coloradohealhinsiue.org/daa.jsp

Horrigan, J. B. Broadband adopion in 2007. Pew Inerne and American Lie Projec. Rerieved April 7, 2009, rom htp://www.pewinerne.org/

Press-Releases/2007/Broadband-Adopion-in-2007.aspx

LaRose, R., J. L. Gregg, S. Srover, J. Sraubhaar, and S. Carpener. Closing he rural broadband gap: promoing adopion o he inerne in rural

America. Telecommunicaions Policy 31, (2007): 359-373.

Lennet, B. Rural broadband and he TV whie space. Issue brie #22. New America Foundaion: Wireless Fuure Program, June 2008. 4 p.NAS Recruimen Communicaions. NAS insighs: physician recruimen repor. Rerieved April 7, 2009, rom htp://www.nasrecruimen.com

MicroSies/healhcare/Aricles/eaureH5b.hml

Spire, M. A review o physician recruimen and raining in rural America. Washingon, D.C. Washingon Healh Policy Fellowship Program, Augus

2000. 16 p. Rerieved April 7, 2009, rom htp://www.unmc.edu/Communiy/ruralmeded/edsloc/RecrRe/naional_view_recruimen.hm

U.S. Census Bureau. Sae and Couny QuickFacs. Rerieved April 7, 2009, rom htp://quickacs.census.gov/qd/saes/08000.hml

Unied Saes Deparmen o Veerans Aairs. VA daa show home healh echnology improves access o care. January 2009. htp://www1.va.gov/

opa/pressrel/pressrelease.cm?id=1637 (accessed April 7, 2009).

Seshamani, M. V. (2008). Hard imes in he hearland: healh care in rural America. Rerieved May 6, 2009, rom HealhReorm.gov: htp://www.

healhreorm.gov/repors/hardimes/

Sources

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Restructuring the Medicaid

All-or-Nothing ThresholdNeil Parikh and Yining Tommy Fu, Rice Universiy

Extending Medicaid coverage on a sliding scale to low-income amilies thatearn just above their Medicaid categorys income threshold can help remove theperverse incentive to not meet ones earning potential solely to receive medicalbenets.

The idea o a sliding scale ee or low-income paiens is currenly undergoing esing inMassachusets (hose making more han 150% o he FPL), and so ar has proven o beeecive only 2.8% o residens are uninsured and spending rom he Healh Saey NeFund dropped by 38% in jus wo years. Despie his cos cu, i mus be noed ha Mas-

sachusets sill leads all oher saes in healh care spending a $6,683 per capia.

Estimate of those affected

Considering he average price oindividual healh insurance premi-ums (nearly $5,000), i is hose in-dividuals who qualiy under a Med-icaid eligibiliy group, and earn lesshan $5000 above he Medicaideligibiliy level ha have he incen-ive o purposeully remain belowhe income hreshold o obainMedicaid benes. Income disri-buion ables and curren Medicaidnumbers lead o an esimae o ap-proximaely 3.6 million aduls wihhe incenive o inenionally lowerheir income or medical benes.However, he number o poenial beneciaries rom his policy is much greaer as evenaduls ouside he [IEL, IEL + 5000] range would have he chance o join he program albei, a a higher premium.

The oal number o people aeced by his policy is dependen on personal preer-ences, in-deph analysis o sae-by-sae income disribuions, and specic sae-by-saeincome hresholds, and may be addressed aer he policy is implemened. In he mean-while, covering he 3.6 million aduls ha are he mos aeced by he policy would cos$7.7 billion. This esimae does no include he premiums paid by paiens, which wouldlikely lower he overall cos.

Possible Mechanism

Because each sae ses is own income hresholds or Medicaid eligibiliy, his proposalwould aec paiens in each eligibiliy group and in each sae slighly dierenly. Theproposal would oer Medicaid benes a a subsidized premium x% o y, where x

Key FactsAn esi maed 3.6 million Americans have -nancial incenive o lower heir income juso gain Medicaid benes because heirearnings above he eligibiliy hreshold are

less han he value o healh insurance.In 2007, only 47% o amilies earning lesshan $40,000 were oered employer-spon-sored healh insurance.Medicaid spends on average $2,142 peradul Medicaid enrollee. Privae insurance,meanwhile, charges an average premium o$4,700 or each adul enrollee.

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represens he percenage ha he paiens income is higher han he income eligibiliyhreshold, and y represens a fa rae a approximaely he individual insurance premium.

SS(N-wC:$21,203IT)

Next Steps

Considering Medicaids sruc-ure, i is crucial or sae leg-islaors o become involved inhis ype o policy revision andrehink heir eligibiliy crieria.

Consisen wih he exisingmaching scheme, his revisedproposal will incenivize saegovernmens o increase heirincome hreshold, so ha heederal governmen will sub-sidize he healh coverage oeven more people.

Talking PointsMedicaid provide s ull medical benes (opera-ions, prescripions, visis) o all qualiying individ-uals earning less han a sae-conrolled hresh-old, bu oers nohing or similar individuals whoearn jus above he hreshold.

The majoriy o Americans considering Medicaidassisance work low-income jobs. Unlike pro-essionals and oher whie collar workers, heseAmericans are unlikely o see $5,000 in immedi-ae raises or bonuses. Thereore, i is possibleha hese workers will perpeually remain belowhe hreshold, in ear ha once hey rise above i,hey will lose healh insurance.

Esimaes o he Number o Uninsured Children Who Are Eligible or Medicaid or SCHIP. Congressional Budge Oce - Home Page. 13 Apr.

2009 .

Facs and Figures 03 2008. MA Healh Connecor. 13 Apr. 2009 .

Fewer low-income parens are being oered healh insurance on he job, or are able o aord i privaely. Rober Wood Johnson Foundaion. 22

May 2009

Healh Care in Crisis: 14,000 Losing Coverage Each Day. Cener or American Progress Acion Fund. 13 Apr. 2009 .

Healh Spending per Capia. Kaiser Sae Healh Facs. 22 May 2009

The Henry J. Kaiser Family Foundaion - Healh Policy, Media Resources, Public Healh Educaion & Souh Arica - Kaiser Family Foundaion. 13

Apr. 2009 .HINC-06Par 1. U.S. Census Bureau. 23 May 2009

Medicaid Paymens per Enrollee, FY2006 -. Kaiser Sae Healh Facs. 13 Apr. 2009 .

NCHC | Facs Abou Healhcare - Healh Insurance Coss. NCHC | Home. 13 Apr. 2009 . NESARA-

Naional Economic Sabilizaion and Recovery Ac. 13 Apr. 2009 .

Repor rom Massachusets Secreary o Healh and Human Services Timohy Murphy, o he Massachusets General Cour, Chaper 58 Imple

menaion Updae. June 12, 2006.

Toal Medicaid Enrollmen, FY2006 -. Kaiser Sae Healh Facs. 13 Apr. 2009 .

Sources

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Beneficiary-Centered Assignment

For Medicare Part DTammie Chau, Universiy o Caliornia - San Diego

By matching beneciaries current medication regimen with the right prescriptiondrug plan, the states Department o Health Services can improve beneciariesaccess to necessary drugs while lowering the cost to the beneciary, states, andthe ederal government.

Beneciary-Cenered Assignmen, a mehod o maching individuals drug needs o a or-mulary plan, is a cos eecive sraegy o beter serve Medicare-Medicaid dual eligibles.Over 6.2 million low-income seniors and disabled ciizens qualiy or boh Medicare andMedicaid coverage. These dual eligibles are randomly assigned o prescripion drug

plans (PDPs). These privaely-adminisered PDPs can vary depending on covered drugbenes, premiums, co-paymens, and he low-income ederal subsidy. As consumers,enrollees have he opion o changing heir drug coverage using Medicares Web-basedPlan Finder. However, he majoriy o dual eligibles do no explore available online op-ions and remain enrolled in randomly assigned PDPs.

Using Maine as an example,saes should assis in enrollingand reassigning dual eligibles o

low-cos drug plans ha bene-ciaries needs. The process be-gins by reviewing he las hreemonhs o an individuals drugregimen and comparing he po-enial ou-o-pocke expenses.Saes should collaborae wihheir pharmacis associaionsincluding pharmacy sudens o

use Medicares Plan Finder. InMaine, i an enrollees plan doesno cover 85 percen o hemedicaions hey currenly ake,hen he sae can swich drug plans on behal o he beneciary. Each paricipan is hennoied by leter abou he swich and can op- ou i hey preer no o have heir planchanged.

On January 1, 2006, dual eligibles ransiioned rom Medicaids comprehensive drug

coverage o auomaic enrollmen in Medicare Par Ds PDP. This random assignmenensured ha each drug plan had equal amouns o enrollees insead o ailoring a plano beneciaries. Random assignmen o eligible enrollees no only complicaed bene-ciaries access o prescripion drugs, bu also resuled in higher coss or he ederalgovernmen and saes.

Key FactsDual elig ibles are hose who qualiy or boh

Medicare and Medicaid. They disproporion-aely have muliple chronic condiions requir-ing an average o en (10) or more prescripionsper monh.An esimaed oal o $47 billion and $53 billionwill be spen in 2009 and 2010, respecively,on Par D drug benes.Random assignmen o common pharmaceu-icals can cos a monhly dierence o $242

more han he leas expensive drug plan.

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Random assignmen o PDPs o dual eligibles makes i more dicul or enrollees o ob-ain necessary drugs. For example, i a drug is no included on he approved lis, hen hebeneciary mus pay ou-o-pocke or orego he drug enirely. Allowing saes o beteraccommodae dual eligibles wih Beneciary-Cenered Assignmen provides coverageor curren medicaion regimens wihou causing discrepancy in access o prescripiondrugs. The poenial savings or saes and he ederal governmen is subsanial in main-aining his coverage.

Widespread use o Beneciary-Cenered Assignmen could sreamline enrollees inojus several o he available PDPs. In urn, his could infuence privae plans o compee

or enrollmen based onadding common drugs oormularies.

Next StepsThere is an ongoing chal-lenge o beter serve dualeligibles wih heir specialhealh needs. Decreasinghe widespread conusionor dual eligibles, Medi-care Par D should nd analernaive mehod o en-

rolling beneciaries inoa prescripion drug plan.Sae legislaors can enac

Beneciary-Cenered Assignmen by aking seps o obain auhoriy graned rom CMSo give sae pharmacis associaions auhorizaion o auomaically enroll dual eligiblesino cos saving plans ha mach he beneciaries curren drug regimen.

Talking PointsCurren assi gnmen o dual eligibles is random and

based upon equalizing he number o enrollees ineach privae drug plan.Beneciary-Cenered Assignmen or inelligen as-signmen assigns dual eligibles o a prescripion drugplan ha mees he individuals needs.Maine is he only sae wih auhoriy graned romhe Ceners or Medicare and Medicaid Services(CMS) o reassign dual eligibles o plans ha cover60 percen o 95 percen o heir drugs by evaluaing

beneciaries drug regimens and plan opions.

Laura Sumner e al, Improving he Medicare Par D Program or he Mos Vulnerable Beneciaries. Com-monwealh Fund, May 2007.

Jack Hoadley e al, The Role o Beneciary-Cenered Assignmen or Medicare Par D MedPAC, June 2007.

The Medicare Prescripion Drug Bene- An Updaed Fac Shee. Henry J. Kaiser Family Foundaion, March

2009.

Vernon Smih e al, The Transiion o Dual Eligibles o Medicare Par D Prescripion Drug Coverage: Sae

Acions during Implemenaion Henry J. Kaiser Family Foundaion, February 2006.

Sources

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Patient-Centered Reimbursement

For Chronic DiseasesJamie Cohen and Andreas Shepard, Amhers College

Health care reimbursement methods that ollow the patient can help supporthealth care providers who are preventing and controlling chronic diseases.

Seveny percen (70%) o healh care coss in America are spen on people wih chronicdiseases. As a resul, proper prevenaive care and chronic disease managemen couldresul in huge cos savings and qualiy o lie improvemens. For example, he Cener orDisease Conrol esimaes ha every $1 invesed in oupaien raining ha helps indi-viduals wih diabees manage heir disease saves $8.76 in reduced healh care coss. Theyurher esimae ha oo-care programs ha include regular examinaion and paien

educaion could preven 85% percen o he ampuaions caused by diabees.

While he imporance o prevenion is broadly acceped, creaing incenives o encour-age prevenion has been dicul. Tradiional privae healh insurance has litle inceniveo cover prevenive services, since paiens are likely o change insurers beore he sav-ings are realized. Merely manda-ing coverage o cerain prevenivehealh benes, however, is oeninsucien. There mus be a way

o evaluae wheher and how e-ecively he care is being used.New advances in healh inorma-ion echnology can help addresshis need by creaing ways o moni-or wheher paiens are getinghe prevenive care hey need andensuring ha docors are compen-saed or keeping paiens healhy

in he long erm.

Analysis

Invesing in chronic disease managemen programs, prevenaive care, and educaioncan help lower healh care coss and improve qualiy o lie. Alhough no all preveniveservices programs are he same, he ederal governmen should require privae insur-ance companies o reimburse providers or chronic disease managemen and prevenionservices, according o sandards governed by he CDC Prevenive Services Taskorce.Improved reimbursemen mehods are also needed o nancially reward hose docorswho provide he bes care, who under he curren sysem are rewarded wih more rev-enue i hey le heir paien condiions worsen o he poin where cosly inervenionsare necessary.

In order o rack wheher paiens are achieving heir healh goals, he organizaion omedical records will need improvemen. The mos promising avenues are elecronic orms

Key FactsNaionwi de, spending on paiens wih

chronic diseases accouns or 70% o healhcare expendiures.The Cener or Disease Conrol esimaesha every $1 invesed in oupaien rainingha helps individuals wih diabees manageheir disease saves $8.76 in reduced healhcare coss.One-hird o kidney ailure complicaionsrom diabees are prevenable.

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o healh racking, such as ully elecronic personal medical records and sel-reporinghrough social neworking applicaions. The curren adminisraion has a head sar onhis process, since he economic simulus package included a provision esablishing heOce o he Naional Coordinaor or Healh Inormaion Technology, bu any sysemha oce creaes mus enable he key eaure o maching o paiens achievemen ohealh goals wih heir providers reimbursemen.

The challenges o conrolling hecoss o chronic diseases are be-ing el across he counry, andwill likely be amplied i healhreorms increasing access ohose wihou healh insuranceare passed. In order or any suchhealh reorm o have a susain-able cos in he long erm, pay-men reorms will be needed. Theshor-erm coss esablishinga more robus elecronic healhracking sysem and o makinghe rs addiional paymens oproviders ha are helping heir

paiens mee healh goals will be ouweighed in he long run wih ewer and betermanaged chronic diseases. Regardless o wheher reorms increasing access are passed,he exising healh care sysem, which already consumes 1/7h o GDP and coninues ogrow, should be reshaped along similar lines.

Next Steps

A saring poin or his new reimbursemen model is sae or ederal healh insuranceprograms, including Medicare, Medicaid, or sae healh insurance opions, like Com-monwealh Care in Massachusets. Medicare especially may bene rom he improvedmanagemen o chronic diseases, since he greaes coss o chronic diseases are ound

in older paiens.

Talking PointsFee-or- service reimbursemen sysems,like Medicare, reward providers who allowpaiens condiions o worsen o he poinwhere hey need expensive inervenions.Providers who preven heir paiens romdeveloping chronic diseases or help heir

paiens keep heir chronic diseases in checkreceive very litle nancial reward.Conrolling he coss o chronic diseases willbe imporan o conrolling overall healh carecoss.

Halvorsen, George. 2007. Healh Care Reorm Now!. San Francisco: John Wiley & Sons, Inc.

Ceners or Disease Conrol and Prevenion. Prevening Diabees and Is Complicaions. Revised Sepem

ber 5, 2008. htp://cdc.gov/nccdphp/publicaions/acshees/Prevenion/diabees.hm

Medicine Online. Seve Coll. Think Tank blog pos: June 9, 2009.

Sources

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Nutrition Information

at Point of PurchaseKelsey Jones, Universiy o Georgia

Congress should take immediate action to require that restaurants provide basicnutrition inormation at point-o-purchase and use innovative technology to dis-seminate this inormation, engaging consumers in the process o actively improv-ing their health.

This policy uses a wo-pronged approach o achieve is goals o improved Americanhealh. Firs, Congress should ake immediae acion requiring ha resaurans providebasic nuriion inormaion a poin-o-purchase. Second, he U.S. Deparmen o Healhand Human Services (DHHS) should capialize on he availabiliy o his nuriion inorma-

ion o encourage individual-based, personalized healh promoion sraegies via onlineand mobile phone-cenered healhy eaing programs.

Managed by he DHHS, he primaryaspec o his policy would requireood producers o display calorie,a, choleserol, sodium, carbohy-draes, and proein conen along-side or below each produc o oer

visible, easy access o such inor-maion. Addiionally, he Food andDrug Adminisraions Recommend-ed Daily Nuriion Values wouldappear elsewhere on he menu, al-lowing consumers o use his inor-maion as a poin-o-reerence whenevaluaing he healh qualiy o mealpurchases.

To maximize he programs eeciveness, DHHS should complemen he program wiha echnology-based educaional campaign o encourage healhy eaing habis and per-sonalized wellness plans. This policys disseminaion will build upon curren governmen-sponsored inerne resources, such as he U.S. Deparmen o Agriculures My Pyramidwebsie. Incorporaing resauran nuriion inormaion ino he websies ood daabase,promoing hese web-based personalized healh and weigh loss plans hrough publiceducaional campaigns, and adaping wellness programs o new echnology such assmar phone applicaions will allow consumers o apply hese resources o heir needs.

Moreover, such echnology resources use will allow consumers o creae individualizedhealh proles such ha he applicaions recognize and respond o healh concerns suchas allergies, low-sodium dies, limied calorie inakes, choleserol needs, and so orh,when a consumer chooses o dine a a resauran.

Key FactsThe Un ied Saes aces an obesiy epi-demic, wih he prevalence o obesiy dou-bling in he las weny years and he naionrefecing a rae o 66 percen o Americans

ha are overweigh or obese.Much o his obesiy crisis sems romAmericans consumpion o unhealhy res-auran meals. Sudies show ha i resau-rans provide nuriion inormaion o con-sumers, preerences shi oward healhiermeal ares.

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The number o overweigh Americans has risen dramaically in recen decades, promp-ing he U.S. Surgeon General o deem obesiy an epidemic. Signicanly, obesiy ac-couns or over 300,000 deahs per year and he presen generaion o youh may nooulive heir parens. In aggregae economic erms, obesiy coss he Unied Saes over$117 billion annually. Coinciding wih growing obesiy raes, sudies show a signicanincrease in he consumpion o resauran ood, which is ypically more dense in calories,as, sodium and sugars han a-home alernaives. Sudies show ha providing resau-ran parons wih nuriion inormaion resuls in a shi in consumer preerences, allowingor a more ecien marke. Healh proessionals sugges ha as consumers move awayrom high-calorie, high-a dishes, resaurans will ollow sui by replacing hose oodswih healhier opions.

This policy arms consumers wihhe abiliy o make inormed choic-es while avoiding poenial ine-ciencies o alernaive governmenprograms, such as oulawing ransas or axing resaurans wih lesshealhy ares. I minimizes admin-israive coss associaed wih im-posing and enorcing governmensandards wihin he privae secor.Finally, by using new echnologyporals such as cell phone applica-ions, individuals will have viruallyunlimied access o hese resourceswhich hey can personalize o heirown healh needs.

Talking PointsA policy mandaing nuriion inormaion on

menus will equip consumers wih he skillsneeded o make healhier dining choiceswhile requiring minimal governmen iner-venion and regulaion.While benecial, menu labeling cannoprovide all he inormaion ha individualconsumers may desire or need; Congressshould use nuriion inormaion rom res-aurans o provide consumers wih more

comprehensive, low-cos healh resourcesand plans hrough new echnology porals(such as he web and mobile phones).

U.S. Deparmen o Healh and Human Services (DHHS), The Surgeon Generals Call o Acion o Preven and Decrease Overweigh and Obesiy

(Rockville, MD: U.S. Deparmen o Healh and Human Services, Public Healh Service, Oce o he Surgeon General, 2001), XI.David B. Allison, PhD, Kevin R. Fonaine, PhD, JoAnn E. Manson, MD, DrPH, June Sevens, PhD, and Theodore B. VanIallie, MD, Annual Deahs

Atribuable o Obesiy in he Unied Saes, Journal o he American Medical Associaion 282, no. 16 (1999): 1535.

S. Jay Olshansky, PhD, Douglas J. Passaro, MD, Ronald C. Hershow, MD, Jennier Layden, MPH, Bruce A Carnes, PhD, Jacob Brody, MD, Leonard

Hayfick, PhD, Rober N. Buler, MD, David B. Allison, PhD, and David S. Ludwig, MD, PhD, A Poenial Decline in Lie Expecancy in he Unied

Saes in he 21s Cenury, New England Journal o Medicine 352, no. 11, 1143.

U.S. Deparmen o Healh and Human Services, Prevening Obesiy and Chronic Diseases hrough Good Nuriion and Physical Aciviy,

Ceners or Disease Conrol and Prevenion, htp://www.cdc.gov/nccdphp/publicaions/acshees/Prevenion/obesiy.hm (accessed Ocober

8, 2007).

Shanhy A. Bowman, PhD and Bryan T. Vinyard, PhD, Fas Food Consumpion o U.S. Aduls: Impac on Energy and Nurien Inakes and Over

weigh Saus Journal o he American College o Nuriion 3, no. 2 (2003): 167.

Naional Resauran Associaion, Frequenly Asked Quesions, Naional Resauran Associaion, htp://www.resauran.org/abouus/aqs.cm

(accessed Ocober 12, 2007).

Buron e al., 1673.

Buron, 1674.

Fred Kuchler, Elise Golan, Jayachandran N. Variyam, and Sephen R. Crucheld, Obesiy Policy and he Law o Uninended Consequences U.S.

Deparmen o Agriculure Economic Research Service, htp://www.ers.usda.gov/AmberWaves/June05/Feaures/ObesiyPolicy.hm (accessed

Ocober 7, 2007).

John C. Kozup, Elizabeh H. Creyer, and Sco Buron, Making Healhul Food Choices: The Infuence on Healh Claims and Nuriion Inormaion

on Consumers Evaluaions o Packaged Food Producs and Resauran Menu Iems, Journal o Markeing 67, (April 2003): 32.

Jayachandran N. Variyam, Nuriion Labeling in he Food-Away-rom-Home Secor: An Economic Assessmen, U.S. Deparmen o Agriculure

Economic Research Service, Economic Research Repor Number 4, htp://www.ers.usda.gov/publicaions/err4/err4.pd (accessed Ocober 12,

2007).

Sources

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Extending Prescribing Privileges

to Clinical PsychologistsJeremy Ford, Universiy o Norh Carolina - Chapel Hill

Extend prescribing privileges to clinical psychologists and prepare them throughtraining programs in drug therapy in order to lower costs and mitigate disparitiesin access to mental health treatment or youth and patients in rural areas.

There has been a persising shorage o psychiariss in he Unied Saes. Due o poorunding and inadequae recruimen rom medical schools, child and adolescen psychia-riss will coninue o be in shor supply, as will psychiariss pracicing in rural pars o hecounry. Some lawmakers have addressed his shorage by allowing clinical psychologisso prescribe psychoropic medicaions drugs or menal illness.

Analysis

Alhough some psychiariss haveexpressed concern ha prescrib-ing psychologiss would provide in-adequae care and could increasehe risk o aal drug ineracionsor children, psychologiss haveproven o be eecive prescribersin various setings aer raining inpharmacoherapy. The Deparmeno Deense launched a projec in1989 o rain miliary psychologissin prescribing psychoropic medi-caions. Aer wo years o raining,supervising psychiariss raed heprescribing skills o graduaes asgood o excellen.

Prescribing psychologiss could generae savings or he menal healh sysem and pa-ien. Psychiariss undergo our years o expensive and broad-based medical rainingo which only six weeks is dedicaed o clinical psychiaric medicine. Psychiariss alsocomplee an addiional our years o residency. Sudens incur deb ha is usually paido by relaively high salaries ollowing residency a cos absorbed by paiens and hehealh care sysem.

Docoral raining or psychologiss is ar less expensive and more specic o menal ill-ness han he medical educaion o psychiariss. Given heir relaively inexpensive rain-ing, psychologiss do no accrue as much deb as medical sudens and usually commandlower salaries han psychiariss.

Key FactsOne in our aduls suers rom a diagnos-able menal disorder, and 6% suer romserious menal illness.There were 6,300 pracicing child psychia-riss as o 2003, whereas an esimaed

30,000 were needed.In 2000, large meropolian areas had 6.9child psychiariss per 100,000 youh, buin rural areas, here were 0.3 psychiarissper 100,000 youh.The average hourly cos o an appoinmenis $62.64 wih a psychiaris and $39.44 wiha psychologis.

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Stakeholders

Americans o all ages wih menal disorders, especially hose living in rural areas, could

bene rom his policy. They would have increased access o necessary psychoropicmedicaions and a greaer abundance o prescribers. They would also experience grea-er savings due o lower ransporaion and provider coss. Psychologiss could bene

economically and proessionally rom expanded career choices. Psychiariss would con-inue o oer a compeing approach ha ocuses on pharmacological inervenion raherhan psychoherapy.

Next Steps

Lawmakers should address heshorage o psychiaric serviceshrough ederal legislaion mod-eled aer recen sae legislaion

in New Mexico and Louisiana.Following bill passage and pro-gram developmen a academicinsiuions, he Unied Saescould have is rs generaion oprescribing psychologiss o reaunderserved populaions in oneo wo years.

Talking PointsAer raining in drug herapy, psychologissare procien prescribers o psychoropicmedicaions.

An increased supply o prescribing menalhealh proessionals could address shor-ages in rural and child menal healh care.Training prescribing psychologiss would besignicanly less cosly han raining newpsychiariss, generaing savings or menalhealh sysems and paiens.

Kim, W.J. Child and Adolescen Psychiary Workorce: A Criical Shorage and Naional Challenge. Aca

demic Psychiary 27(4):277-292.

Kessler, R.C., Chiu, W.T., Demler, O.,Walers E.E. Prevalence, severiy, and comorbidiy o welve-monh

DSM-IV disorders in he Naional Comorbidiy Survey Replicaion (NCS-R). Archives o General Psychiary

62:617-627 (2005).

Baes, B. Child Psychiariss in Huge Demand: Shorage Deemed a Dire Problem Clinical Psychiary News

31:1-5 (2003).

Levin, A. Rural Counies Suer From Child Psychiary Shorage Psychiar News 41:4 (2006).

Pingiore, D.P., e al. Comparison o Psychologiss and Psychiariss in Clinical Pracice. Psychiaric Services

53:977-983 (2002).

Naional Alliance on Menal Illness. Prescribing Privileges or Psychologiss: An Overview 2002. htp://

www.nami.org/Templae.cm?Secion=Issue_Spolighs&emplae=/ConenManagemen/ConenDisplay.

cm&ConenID=8375.

American Academy o Child and Adolescen Psychiary. AACAP Sae Psychologis Prescribing Updae.

(2005).

Naional Alliance on Menal Illness. Prescribing Privileges or Psychologiss: An Overview (2002). htp://

www.nami.org/Templae.cm?Secion=Issue_Spolighs&emplae=/ConenManagemen/ConenDisplay.

cm&ConenID=8375.

Galka, S.W., e al. Medical Sudens Atiudes Toward Menal Disorders Beore and Aer a Psychiaric Roa

ion. Academic Psychiary 29:4 (2005).

Salary o Benes o Psychiaric Residency Program or he Universiy o Washingon. htp://deps.washingon.edu/psychres/salary.shml.

American Psychological Associaion. Singleon, D., Tae A, and Randall, G. Repor o he 2001 APA Salary

Survey (2003). htp://research.apa.org/01salary/index.hml.

Psychiaris Salaries (2009). htp://swz.salary.com/salarywizard/layouhmls/swzl_compresul_naional_

HC07000027.hml

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Analysis

The sigma associaed wih menal illness in he miliary is one o he many challengesveerans mus overcome when accessing menal healh services. Because soldiers earhe proessional consequences o being diagnosed wih a menal illness, hey oen avoidreamen and insead serve muliple comba ours while suering rom a menal illness,

impairing heir service. The social sigma associaed wih menal illness has also led manyveerans o abuse alcohol or drugs in order o rea heir illness, creaing a large popula-ion o veerans wih co-occurring menal illnesses. Peer suppor specialiss provide aunique suppor nework or reurning veerans and can also serve as a non-hreaeningenry poin ino he menal healh sysem. The opporuniy o access peer services willlead o greaer awareness and recogniion o menal illness in he miliary, combaing hesigma associaed wih i.

Menal healh services are mos o-

en accessed by veerans a Veer-ans Adminisraion Hospials which,due o disance or unsable rans-poraion opions, can make uiliz-ing hose services requenly or inan emergency dicul. By rainingveeran peer suppor specialisslocaed in communiies hroughoueach sae, veerans will be able o

access services on a local level. Inaddiion, he use o social nework-ing sies will allow or easy accesso peer services. Through argeeduse o hese online resources, hepeer suppor program will be able

o reach he many young reurning veerans who communicae more reliably hroughonline services.

Talking PointsVeeran peer suppor programs creaepaid proessional opporuniies or veer-ans and develop imporan resources orreurning veerans.Peer suppor specialiss serve as an im-poran supplemen o radiional menalhealh services, easing he srain on hecurren veeran menal healh sysem.

Menal healh resources are no a bene ha should be given o veerans, raherhey are an enilemen ha veerans haveearned hrough heir service o America.

Armsrong, Moe. Wha is Peer Suppor?. Veeran Recovery. htp://www.veeranrecovery.med.va.gov/peer_

suppor/Wha_is_peer_suppor.pd (accessed June 11, 2009).

Veeran Recovery - Job Descripion PEER SUPPORT SPECIALIST, GS5 - Menal Healh Service. Welcome

o Veeran Recovery. htp://www.veeranrecovery.med.va.gov/announce/posiions/Peer_Suppor_Speciais_

Posiion_Descripion.hm (accessed June 11, 2009).

Armsrong, Moe. Wha is Peer Suppor?. Veeran Recovery. htp://www.veeranrecovery.med.va.gov/peer

suppor/Wha_is_peer_suppor.pd (accessed June 11, 2009).

Americas Wounded Warriers. Veerans or America. www.veeransoramerica.org/wp-conen/uploads/2007/12/rends-in-reamen-r2.pd (accessed June 11, 2009).

Cener or Communiy Suppor & Research, Wichia Sae Universiy. Ves4Ves Program Evaluaion. Ves 4

Ves - Peer Suppor For Iraq And Aghanisan-Era Ves. htp://www.ves4ves.us/ (accessed June 11, 2009).

Ibid

Alvarez, Lizete. Aer he Batle, Fighing he Botle a Home - Series - NYTimes.com. The New York

Times - Breaking News, World News & Mulimedia. htp://www.nyimes.com/2008/07/08/

us/08veshml?pagewaned=1&_r=1 (accessed June 11, 2009).

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Expanding Personal Control

of Electronic Health RecordsEva Galvan, Yale Universiy

Health inormation technology eforts should be expanded to include the cre-ation o an online, integrated personally-controllable health record (PCHR),which would monitor the advancement o certain long-term illnesses by suggest-ing tailored action plans according to the patients specic condition.

The 2009 simulus package has dedicaed unding or healh care providers o adophealh inormaion echnology (HIT). To ose he cos and diculies encounered inadoping HIT, he simulus package includes a provision or elecronic healh records(EHRs) wih various eaures such as paien demographic and clinical healh inorma-

ion.

The Unied Saes Depar-men o Veerans Aairs hasalready regisered hundredso housands o veerans ouse MyHealheVe, a PCHRwebsie, o nd caregivers, ap-ply or prescripion rell, rack

labs, and keep ood and aciv-iy journals, among many oherservices.

While he simulus package hasalready oulined erms o EHRdevelopmen and HIT imple-menaion, an easily undersandable, paien-accessible sysem such as PCHRs incorpo-raed ino new HIT programs is a logical and criical nex sep. The ederal governmen

could provide overall coordinaion or his iniiaive hrough a new online poral, My-Healh.gov, modeled aer MyHealheVe.

Analysis

Upgrading and sandardizing EHRs o allow or paien access online will improve hequaliy o care ha paiens receive and ensure ha paiens can beter manage heirown reamen. The benes o creaing a simple PCHR sysem ar exceed any cos ocreaing and disribuing i alongside he upgraded HIT ha hospials will be receivinghrough he simulus package. Close monioring o chronic illnesses such as diabees willlessen heir overall impac on and cos o American sociey.

To be successul, PCHRs would have o be no only as and simple or he docor ouse during appoinmens bu also easy or he paien o undersand. The MyHealheVewebsie has achieved his goal wih is Frequenly Asked Quesions secion and clearexplanaions o he resources i oers. Wellness Reminders such as he ones used by

Key FactsThe 2009 si mulus package provides gransaround $19 billion o healh care providers osuppor he adopion or upgrading o healh in-ormaion echnologies.Over wo-hirds o hospials had a leas parial-ly implemened EHR programs in 2006, and 10

percen o hospials were using compuerizedphysician order-enry.Healh adminisraion coss in 1999 oaled aleas $294.3 billion in he U.S., or $1,059 per capi-a, while Canada spends $307 per capia.

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he MyHealheVe PCHR websie can remind paiens o appoinmens or o adhere oliesyles consisen wih mainaining healh.

Stakeholders

Everyone benes rom he implemenaion o inegraed PCHRs; however, paiens a

risk o or suering rom chronic illnesses and muliple co-morbidiies will be mos a-eced because he mos signican gains can be made hrough personalized diseasemanagemen. The burden o using his program o is ull poenial will res wih medicalproessionals and aciliy adminisraors, who will have o make sure he paien under-sands how o access he useul inormaion, and wih paiens, who have o make hecommimen o access he inormaion.

Next Steps

The rs sep o imple-

mening an inegraed,paien-accessible PHRprogram is o nd und-ing, eiher rom Con-gress or hrough exis-ing unding direced ohe Oce o he Na-ional Coordinaor orHIT. The Naional Co-

ordinaor should henoversee he design oa fexible, uniorm pro-gram, compaible wihhe EHR programs al-

ready unded by he simulus package. The program mus be writen hrough close col-laboraion beween public healh expers, medical proessionals, program designers, andany exising privae programs. The las phase will involve implemenaion and expansionmeasures similar o hose being envisioned or he baseline EHR programs.

Talking Points

Alhoug h he simulus package has provided undingor EHRs, i ailed o provide or a comprehensive pa-ien-accessible sysem.Upgrading and sandardizing EHRs o allow or paienaccess will improve he qualiy o care ha paiens re-ceive and ensure ha paiens can beter manage heirown reamen.Creaing a paien-accessible sysem is currenly ea-sible because o ongoing iniiaives or large-scale up-

grades in HIT; he collaboraion o develop a baselineEHR sysem should addiionally be required o ine-grae paien access.

Coninued Progress: Hospial Use o Inormaion Technology. American Hospial Associaion. 2007. (accessed April 5, 2009).

My HealheVe The Gaeway o Veeran Healh and Wellness. The Unied Saes Deparmen o Veeran

Aairs. 30 April 2009. (accessed May 5, 2009).

Speaker Nancy Pelosi: American Recovery and Reinvesmen Ac. (accessed April 5, 2009).

The American Recovery and Reinvesmen Ac o 2009. (accessed April 5, 2009).

Woolhandler, See, Campbell, Terry, Himmelsein, David U. Coss o Healh Care Adminisraion in he

Unied Saes and Canada. N Engl J Med, 349 (2003) 768-775.

Sources

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Using Municipal Identification Cards

as Gateways to Health ServicesLauren Huner, Greg Mitl, Jessica Becker, and Eva Galvan, Yale Universiy

Municipal ID cards can increase access to ree and low-cost health services,especially or immigrants and the uninsured.

Ciies across he counry have recenly implemened municipal idenicaion cards, rec-ognizing he poenial or such cards o incorporae immigrans and oher underrepre-sened groups ino he ciy communiy. Like drivers licenses, municipal ID cards con-ain he bearers phoograph, address, and dae o birh, as well as a unique ideniyingnumber and an expiraion dae. Unlike drivers licenses, all ciy residens regardless oimmigraion saus may obain municipal ID cards.1 The rs such card was New Havens

Elm Ciy Residen Card (ECRC), which has inspired programs in oher ciies, noablySan Francisco.2

In addiion o acing as a orm oidenicaion, some municipal IDcards oer services, such as debi orlibrary capabiliies. In March 2009,he Elm Ciy Residen Card waslinked o a program ha oers a 20

percen discoun on all prescripiondrugs a CVS pharmacies, makinghis discoun available o uninsuredNew Haven residens wih an ECRC.3The incorporaion o a prescripiondrug discoun ino a municipal IDcard was a rs sep oward uilizinghese cards as gaeways or healhservices.

Analysis

There are several ways in which a municipal ID card can increase residen access oree and low-cos healh services. One possible approach is o embed personal healhinormaion on he card isel an especially compelling opion since healh providersregularly sruggle o locae he medical hisories o immigrans and he uninsured. Thecard could simply display basic healh inormaion, such as he bearers allergies andorgan donor saus. A more complex version o he card would be an elecronic healhrecord oering a comprehensive medical hisory.

Several opions require greaer involvemen on he par o he municipal governmen. Aciy can compile inormaion on low-cos healh care and include a box on he ID cardapplicaion orm ha residens can check in order o receive he compilaion whenhey receive he ID card. This approach responds o he disjoined and conusing naureo American healh care by providing sraighorward insrucions or access. Anoher

Key FactsAs o 2 005, here were 46.6 million un-insured Americans (15.9 percen o hepopulaion).4

Immigrans use abou hal as many healh

services as U.S.-born individuals.5Abou 10 percen o all ambulaory healhcare expendiures are or emergencyroom services.67370 New Haven residens have appliedor he Elm Ciy Residen Card.7

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opion or ciy governmens is o marke he card as a sae space icon o he immigrancommuniy. For example, a ciy could creae a program or amiliarizing providers wihimmigran healh and nancial needs. When providers complee he program, hey areceried by he ciy and can, perhaps, display he ID card icon in heir oce.

The coss o implemening and mainaining he ID cards are minimal. New Havens cardis acually unded by supporive organizaions ouside o he ciy governmen.8 The cosso he healh componens are also small and consis primarily o adminisraive ime in-vesed in communicaing wih providers, advocacy groups, ec.

Stakeholders

Reassuring immigrans ha providers are amiliar wih heir needs and presening heuninsured wih nancially-easible healh care opions will encourage boh groups o visiphysicians earlier, conribuing o heir well-being. In addiion, signican nancial ben-

es fow o he axpayer. When he uninsured and impoverished are nancially able oaccess prevenaive services, heir cosly use o emergency rooms decreases. Lasly, heenire ciy is srenghened when is members eel sae, healhy, and valued.

Next Steps

Wih more han 7,000 peoplesigned up or he ECRC in NewHaven, and oher ciies imple-mening or proposing similar

cards, he uure o he munici-pal ID card as a healh servicegaeway may be a a urningpoin. Ciy governmen bohhe execuive and legislaivebranches mus suppor hecreaion o municipal ID cards.Incorporaing healh compo-nens ino exising cards can

involve collaboraion beweenciy governmen and communiyhealh ceners, hospials, andmyriad advocacy groups.

Talking PointsMunicipa l ID cards can become navigaionools or ragmened and conusing healh sys-ems, providing residens immigrans and he

uninsured, in paricular increased access oneeded healh services.Connecing municipal ID cards o low-coshealh services saves axpayers money by re-ducing he burden o immigrans and he unin-sured on our emergency rooms.Municipal ID cards, especially when hey in-clude a public healh componen, encourageimmigrans o become sakeholders in he

communiy, improving residen relaionshipsand decreasing crime.

1. Maos, Kica. The Elm Ciy Residen Card: New Haven Reaches Ou o Immigrans. New England Communiy Developmens 4 (2008): 1-7.

2. SF Ciy ID Card. Ciy and Couny o San Francisco, Oce o he Couny Clerk. 2 Apr. 2009 .

3. New Haven Prescripion Discoun Card. Ciy o New Haven. 2 Apr. 2009 .

4. The Number O Uninsured Americans Is A An All-Time High. 29 Aug. 2006. Cener on Budge and Policy Prioriies. 2 Apr. 2009 .

5. Mohany, Saria A., e al. Healh Care Expendiures o Immigrans in he Unied Saes: A Naionally Represenaive Analysis. American Journal

o Public Healh 8 (2005): 1431-1438. .

6. Machlin, Seven R. Expenses or a Hospial Emergency Room Visi, 2003. Medical Expendiure Panel Survey. Jan. 2006. Agency or Healhcare

Research and Qualiy. 2 Apr. 2009 .

7. Lu, Carmen. ID card drive aims o draw Elis. 1 Apr. 2009. Yale Daily News. 2 Apr. 2009 .

8. Maos, Kica. The Elm Ciy Residen Card: New Haven Reaches Ou o Immigrans. New England Communiy Developmens 4 (2008): 1-7.

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can be implemened readily wih ngerprin scanners as inexpensive as $30. Meanwhile,savings rom he reducion o uncompensaed care are projeced o reach up o $74 mil-lion in Houson alone.

Immigran communiies may be concerned ha healh daa would be conneced o im-migraion daa in order o idenied undocumened ciizens, bu wih appropriae privacysaeguards healh daa can be kep separae. In addiion, i biomeric daa are used oideniy all paiens who come o communiy healh ceners, hen he abiliy o single ounon-ciizens will also be diminished.

Stakeholders

This novel Biomeric-EMR proocol would principally bene undocumened paienssuch as he homeless. They will no longer have o undergo he enire regimen o clinicaless each ime hey visi a healh cener, enabling hem o receive beter care and open-

ing up ime and diagnosic resources or addiional cases. Physicians who rea hese pa-iens also sand o bene.Greaer convenience andspeed in obaining medi-cal hisories will allow hemo rea more paiens andprovide more comprehen-sive care. Lasly, hospialsand clinics will bene rom

reduced congesion andwase o resources.

Next Steps

The auhors have alreadybegun a pilo program ahe HOPE Clinic, a Feder-ally Qualied Healh Cener(FQHC) in Houson, TX, o

assess he cos-saving and eciency benes o his EMR-Biomeric proocol over a six-monh rial period. I successul, he program will seek o inroduce his Biomeric-EMRproocol o clinics in he Houson Meropolian area, he sae o Texas, and ulimaelyaround he U.S. Meanwhile, similar programs can be implemened naionwide in oherceried FQHC clinics. As evidenced by he successes in New York and Minnesoa, i iseasible o inegrae hese biomeric ools wih exising medical insiuions.

Talking PointsFor medical personnel, he greaer eciency, reli-abiliy, and speed o inormaion access enabled bya Biomeric-EMR sysem ranslaes ino beter pro-duciviy and coninuiy o care or paiens.I can also reduce obligaory expenses such as

emergency room services by improving heir e-ciency and prevening wase.The quicker and more convenien check-in processenabled by Biomeric paien idenicaion may in-crease paien saisacion and make primary care amore atracive alernaive o expensive emergencyand caasrophic care.

Biomeric scanner used or hospial securiy. (01-JUN-05) Hospial Access Managemen. AccessMyLibrary - News, Research, and Inormaionha Libraries Trus. 13 Apr. 2009. htp://www.accessmylibrary.com/coms2/summary_0286-12207924_ITM.

Can EMR save you money? Medical Pracice Managemen Trends. 13 Apr. 2009. htp://www.medicalpracicerends.com/echnology/emr-save-

money/.

Lawrence, Sacey. Biomerics Bring Fingerprin ID o Hospials - Healh Care. Research, Bes Pracices and News or Inormaion Technology

Execuives - CIO Insigh. 13 Apr. 2009. htp://www.cioinsigh.com/c/a/Healh-Care/Biomerics-Bring-Fingerprin-ID-o-Hospials/.

NCHC | Facs Abou Healhcare - Healh Insurance Coverage. NCHC | Home. 13 April 2009. htp://www.nchc.org/acs/coverage.shml.

Toal FQHCs - Unied Saes -. Kaiser Sae Healh Facs. 13 April 2009 htp://www.saehealhacs.org/proleind.jsp?ind=424&ca=8&rgn=1.

Combs, Susan. The Uninsured: A Hidden Burden on Texas Employers and Communiies. Texas Comproller o Public Accouns. 13 April 2009.

htp://www.window.sae.x.us/specialrp/uninsured05/.

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The aricles in his journal are jus he surace o he work ha he Healh Policy Cenerhas done his year. In his nal secion, I hope o highligh he some o he grea work hagoes on behind he scenes and he lessons learned or oher sudens who hope o urnheir ideas ino policy.

O course, he Roosevel Insiue Campus Nework is no like mos hink anks. We dono si around in rooms all day and wrie pages and pages o papers ha are desinedor he recycle bin. We engage sudens rom communiies across he counry and aremoivaed by heir resh perspecives o ry and make a angible impac in he world. I isa model ha we have summed up in a simple phrase: Think Impac.

Think Impac is abou so much more han publishing aricles in a journal. I is he processo how we come up wih our ideas and way ha we use he power o our ideas o makereal change. I is easy o dismiss he ideas o young people as nave or inconsequenial,bu in his pas year alone, our ellows have already made a angible dierence. In heyears o come, I have no doub ha our ideas will be changing he world.

ThinkMos o he ideas in his journal were developed in he spring o 2009 a our secondannual suden healh policy conerence. Sudens rom all across he counry convenedin Washingon, DC o hear rom expers, advocaes, and policymakers, including Lau-ren Aronson, he policy direcor orhe Whie House Oce o HealhReorm. From he very sar we werehinking o he audience or our pol-icy ideas.

A selec group o Roosevel ellowsalso paricipaed in a special wriingworkshop o urher heir ideas. Oneo he bes pars o his workshopwas hearing he various perspecivesrom our diverse group o sudensrom all across he counry. No onlydid we hear rom sudens o many

dieren backgrounds, bu we were also able o share ideas wih sudens rom dierendisciplines, such as engineering and business, in order o develop he kind o inerdisci-plinary ideas ha are so imporan or healh policy.

Alhough conerences in Washingon are exciing, he real work o Roosevel happensouside he belway. Wih a nework o chapers a universiies across he counry, he

Think

Think o your audien ce when choosingyour opic.

Value diversiy and bring ogeher manydieren perspecives.Mee wih communiy members anddraw rom your personal experiences inorder o make policy ha is relevan oreal needs.

Center for Health Care

Year in ReviewRober Nelb, Lead Sraegis and Senior Fellow or Healh Care

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Roosevel Insiue Campus Nework is especially equipped o invesigae issues a helocal level. This year, hree o our chapers -- he Universiy o Norh Carolina, Amhers,and Yale Universiy -- organized sie visis wih heir local communiy healh ceners inorder o learn rs hand abou problems in he healh care sysem. By geting ouside heclassroom, our ellows were able o develop new, innovaive ideas, like he Yale healhpolicy ceners aricle in his journal abou using municipal ID cards as a gaeway o helpimprove access o healh services.

Impact

Once our sudens develop new ideas, communicaion is an imporan par o he policyprocess. This journal is jus one o our many policy venues o communicae new ideas.This year we published Roosevelt Rx, our rs journal o suden healh policy ideas; weorganized policy discussions on our blog, and published op-eds and leters o he ediorin major newspapers, including he New York Times.

Words alone are no enough, however, so we have also been acive in organizing evensand projecs o help urn our ideas ino realiy. In addiion o organizing evens in Con-gress o promoe our policies, some o our ellows have been aking acion o imple-men heir policy ideas a he local level. For example, Tommy Fu and Neil Parikh a RiceUniversiy received unding o implemen a pilo program o heir biomerics policy inHouson. Sudens who do no have he resources and connecions o more esablishedorganizaions, bu ha does no mean we canno make a dierence.

Despie all hese successes, wealso know ha change is no easy.I have learned his lesson my-sel hrough a policy idea abouauomaic enrollmen in publichealh insurance programs haI published in one o Roosevelsrs journals. Alhough he ideaseemed simple, change didn

happen overnigh. However, aerpublishing commenary abou he idea in many dieren newspapers and working wihmany dieren parner organizaions, I am now pleased o say ha he idea was recenlypublished by he Brookings Insiuions Hamilon projec and became a par o he re-cenly passed Childrens Healh Insurance Program Reauhorizaion Ac. Change doesnhappen alone and i does no happen overnigh, bu i is possible.

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Impact

Communic ae your idea in many dierenorms.Try ou your idea on he local level, where youmay be able o have a more direc impac.Keey rying, no mater wha.

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your ideas.your leadership.

your issues.

its the new

student activism.

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