Chapter 11: Providing Data to Inform Policy Makers
Files
Loading...
Description
Dr. Elting begins this chapter by talking about how the Affordable Care Act has had an impact on the study of health outcomes. She also notes that the ACA has provided an opportunity for her to provide information to the state legislature in Austin and influence the conversation about healthcare. As an example of the issues she might take on, she explains her work on Medicaid has shown that people who have gaps in insurance coverage have worse outcomes than those with continuous coverage. The latter is ultimately more cost effective.
Next Dr. Elting talks about the mechanisms her office uses to deliver information to Austin. She explains that, as a public institution, MD Anderson can only educate, not lobby. A report goes to every legislator. Individuals specifically interested in public health receive an email and those who interact with legislators on behalf of health issues also receive information.
Identifier
EltingL_02_20150305_C11
Publication Date
3-5-2015
City
Houston, Texas
Interview Session
Linda S. Elting, DrPh, Oral History Interview, March 05, 2015
Topics Covered
The Interview Subject's Story - Overview; The Researcher; Discovery and Success; The History of Health Care, Patient Care; Patients; Patients, Treatments, Survivors; Fiscal Realities in Healthcare; The Healthcare Industry; Politics and Cancer/Science/Care; Women and Diverse Populations; On Texas and Texans; Beyond the Institution; MD Anderson and Government
Transcript
Tacey A. Rosolowski, PhD:
To what extent are some of your pl—are your plans influenced by the Affordable Care Act—the ongoing discussion about the economic environment for providing healthcare?
Linda S. Elting, DrPh:
If you look at it just sort of from 40,000 feet, the plans that are provided by the Affordable Care Act are just another bunch of plans that get added to the long list of plans that we already have, and that we already know are very different from one person and one plan to the next and, you know, that sort of thing. So it has some impact methodologically on how well we can aggregate data. We have to be really careful about coming up with an average cost because, I mean, what’s the average cost? MD Anderson—no provider, including MD Anderson, has an average cost of anything. They negotiate the cost of everything with each individual provider, or payer. So, it adds some methodologic issues. It provides us an opportunity to try and inform the conversation and the decision-making process. My current projects are all focused on Medicaid. I am trying really hard to get this information sent in the direction of Austin. [laughs] They’re making decisions often in the absence of information: not because they’re stupid or don’t look, but because the information doesn’t exist. We’re trying to produce the kind of information that can inform decision-making, particularly for me, right now, in Austin, about expansion of Medicaid. The current work I’m doing on my own in Medicaid, in this stu—in this project shows clearly that people who have gaps in their coverage, or people who only get covered when they get cancer, have much poorer outcomes. And so, we’re actually wasting the money that we spend on Medicaid, because they have terrible outcomes. You know, the people who are diagnosed at an early stage are the people who are continuously covered for months and years before they get cancer, because they’re being managed appropriately and screened. And the people who don’t get covered until the—three days after they know they have cancer all have end-stage disease. Now, I don’t think we should deny care to those people, but our care is not going to result in a cure. You know, and those monies don’t cure cancer, whereas, you know, with breast cancer, you can cure that disease if it’s an early stage. It makes no sense to put your money in the basket of end-stage disease in that setting. It makes more sense to move it to the front and get people covered continuously. But because Medicaid—you have to qualify for Medicaid every six months. You have to reapply. I mean, you can imagine, knowing yourself, what it’s like to try and get insurance coverage. Medicaid beneficiaries do it every six months. And just imagine what it would be like to try to attempt that if you don’t speak English, or if you have no car to go to the office, or if you’re so sick from treatment that you can hardly hold your head up. So, gaps in Medicare cover—Medicaid coverage, and failure to be covered so you can be screened, are causing us to spend money on Medicaid that could be better spent, and have better outcomes.
Tacey A. Rosolowski, PhD:
What is the mechanism that you’re foreseeing, for getting this information to the legislature in Austin?
Linda S. Elting, DrPh:
Well, I guess you could say we use, sort of, three methods. The first one is that when we put out a big report, we send it to every legislator, to their office. It goes to them. So, when we put out a report like that, or a press release, we send it to them, to their offices, so some member of their staff will see it. There are some people who are—who are very involved and interested in public health and in the health of the state. Those legislators we target specifically for, you know, an email or something like that. And then, we get these kinds of information out to people who often speak with the—with legislators. You know, we try to get every—so we send it to the ACS [American Cancer Society] representative in Austin. We make sure they hear it. We send it to the Komen folks. You know, all of those people—to the Armstrong Foundation people if it applies there, to survivorship. We try to get the people who lobby on board. You know, we don’t lobby. We’re state employees. [laughs] But we try to inform their lobbying. We try to inform the decision-making with the kind of information that we produce.
Tacey A. Rosolowski, PhD:
It sounds like a really exciting project.
Linda S. Elting, DrPh:
It’s really cool. Not many people around MD Anderson do this. [laughs]
Tacey A. Rosolowski, PhD:
Yeah, yeah.
Linda S. Elting, DrPh:
They mostly do genes—
Tacey A. Rosolowski, PhD:
Right.
Linda S. Elting, DrPh:
—and cells.
Tacey A. Rosolowski, PhD:
Right. Yeah, and—but this is so important to, you know, have an impact on a community and which is obviously—was part of MD Anderson’s mission from the very beginning.
Linda S. Elting, DrPh:
Yeah, yeah, it is.
Tacey A. Rosolowski, PhD:
Yeah, yeah. We have about five minutes left in our time today. It—would you like to start talking about another type of study you’ve been doing, or do you have some related observations to these issues, about community and health and policy?
Linda S. Elting, DrPh:
No, I don’t—I don’t think I have—I think we’ve gone over my research really well.
Recommended Citation
Elting, Linda E. DPh and Rosolowski, Tacey A. PhD, "Chapter 11: Providing Data to Inform Policy Makers" (2015). Interview Chapters. 715.
https://openworks.mdanderson.org/mchv_interviewchapters/715
Conditions Governing Access
Open
