http://healthpolicy.ucsf.edu Fall 2013

PRL IHPS E-News Philip R. Lee Institute for Health Policy Studies

Improving Health through Policy, Leadership, and Research since 1972

In this Issue Page 2 Health Insurance

Exchanges and their impact on individuals.

Page 8 New Projects at PRL-IHPS

Page 9 Introducing Postdoctoral Fellows

Page 11

Research and Honors Spotlight

Page 15 PRL-IHPS in the News

Story Continues Next Page

Open enrollment for California’s new health insurance exchange – called Covered California – began in October making available health insurance to millions of state residents who are uninsured or who don’t have coverage from their employers. UC San Francisco’s leading health experts talk about the potential impact of these new health care coverage options statewide.

Health Insurance Exchanges: How Will Rollout of the Affordable Care Act Affect You?

Janet Coffman, PhD

Andrew Bindman, MD Claire Brindis, DrPH

Josh Adler, MD

Page 14

Recent Publications

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ACA's Impact at State and National Level

Andrew Bindman, MD, professor in the UCSF Department of Medicine and the UCSF Philip R. Lee Institute for Health Policy Studies, worked as a staff member in Congress to help draft provisions in the Affordable Care Act (ACA).

He currently is involved in implementing the law and evaluating its impact as a senior advisor to the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services in Washington and as the director of the California Medicaid Research Institute in California. Here, Bindman discusses the rollout of the state health exchanges from a national perspective.

Q. Recent polls show that many Americans don’t understand the Affordable Care Act, including the health insurance exchanges, and are uncertain how they will benefit. Is that a concern?

The ACA is a very large law with hundreds of provisions, so it isn't surprising that many Americans don't fully understand it. Different aspects of the law are relevant for different groups of people. What is most important is that Americans have an ability to understand the parts that are relevant for them.

Health insurance exchanges, or marketplaces, are one of the new ideas in the law. Marketplaces have the potential to simplify the search for health insurance and to create competition among sellers of health insurance, but they are not intended to be the method by which the majority of Americans will obtain insurance coverage. These marketplaces will have open enrollment starting Oct. 1, 2013, through March 31, 2014, with a start date of the coverage beginning as early as Jan. 1, 2014.

State and federal officials are supporting a number of organizations to help spread the word and to serve as navigators to help those who could benefit from the marketplace to understand how to use it. For those who want to get a jump start, they can find information on the California Marketplace, called Covered California.

Q. How do the health insurance exchanges work with Medicaid and Medicare?

The marketplace does not apply to those covered by Medicaid (what we call Medi-Cal in California), Medicare, or who obtain their health insurance coverage from an employer.

Health insurance exchanges are designed as a marketplace for individuals seeking to purchase private insurance for themselves and their family.

It is estimated that about 25 million Americans will be eligible to purchase health insurance from a marketplace and as many as 20 million of those are expected, based on their income, to qualify for a federal subsidy to help them and their family purchase their health insurance through a marketplace.

Individuals who are eligible for Medi-Cal or Medicare are ineligible for the federal subsidy to purchase health insurance through a state or federal marketplace.

Q. What do you think consumers need to know and/or misunderstand about the exchanges?

Not all health plans available for individuals to purchase today will be available beyond 2013 or for purchase through marketplaces. In some cases, these plans will be terminated because they do not meet the minimum standards of health insurance coverage that will be applied to health plans beginning in 2014.

Beginning in 2014, individuals may elect to purchase private health insurance outside of a marketplace; however, the available information about plans and prices from California's marketplace (Covered California) suggests that most individual consumers of health insurance will be able to save money by purchasing it through the marketplace.

Q. Do you think the exchanges will make the health care market more competitive?

There are a few key aspects of health insurance exchanges that will promote competition in the health insurance marketplace.

First, consumers purchasing a health plan through a marketplace are given assurances that these plans meet basic standards for quality, consumer protections and provider availability.

Second, marketplaces require that health insurance products be categorized according to standards that will allow consumers to do simple comparison shopping. By providing information about the plans' quality, benefits, providers, premiums, co-payments and deductibles in a side-by-side manner using simple terms, marketplaces can help consumers to make the sorts of choices they make when shopping for other products.

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ACA's Impact on Women & Young Adults

Claire Brindis, DrPH, director of the UCSF Philip R. Lee Institute for Health Policy Studies, is an expert on women’s health services, including the role of preventive health care, such as elimination of out-of-pocket cost sharing for preventive health services under the Affordable Care Act (ACA).

In addition, she has conducted research focused on the role of the ACA in expanding health care coverage for young adults up to age 26 as part of their parents’ health plans. Here, Brindis discusses the changes to health coverage under the Affordable Care Act for women and young adults.

Q. How does implementation of the ACA specifically impact women?

Traditionally, women have played a central role in navigating the health care system not only for themselves, but in their roles as mothers and caregivers, particularly for elders and disabled

family members. Thus, at the core of the potential impact of the ACA on women is the great promise of expanding overall access to health insurance coverage for a large proportion of the 40 to 45 million Americans who have been living without secure health insurance coverage.

The architects of the ACA made major commitments to coverage of preventive health services, many of which disproportionately impact women. There are also financial incentives, but not requirements, for Medicaid to cover these services without cost-sharing.

Coverage of specific services will likely have a greater impact on women’s health, and in turn, the health of their children. These include prenatal visits, screening and access to family planning counseling and all FDA-approved contraceptive methods – one of the most widely used services among women – as well as an annual “well women” visit, screening for domestic violence and pregnancy-related services. These preventive services will also cover women over their life course, including colorectal cancer screening, breast and cervical cancer, osteoporosis, and cardiovascular health (e.g., hypertension, lipid disorders).

The law also includes a provision that permits women in group health plans to have direct access to participating ob-gyns, without needing a primary care provider referral. This access is noteworthy as childbirth and pregnancy-related conditions are leading causes of hospitalizations in the U.S., accounting for nearly 25 percent of hospital stays.

Q. Are there downsides of the health insurance exchanges for women in particular?

Affordability of care is a key issue for women, who are disproportionately low income. In the past, women have been far more likely to report cost-barriers to care for their families and themselves, including that they skipped needed care or

Finally, individuals eligible to purchase health insurance through a marketplace are guaranteed the opportunity to purchase the plan they choose – plans cannot refuse to provide coverage based on an individual's pre-existing condition.

Q. What do you see as the future of the health insurance exchanges, especially for states that opted out of establishing ones this year?

Each state can choose to create and run its own marketplace. Many experts around the country regard California as a leader in how it has set up its marketplace to support consumer choice and buying power.

States that do not choose to create and run their own marketplace can either partner with the federal government to run some marketplace functions or have a marketplace established and operated by the federal government.

The ACA requires that there be a marketplace for all eligible Americans in all 50 states and the District of Columbia. States that do not initially choose to create and run their own marketplaces, may revisit that decision based on the experience of the states that do so, but it may become more challenging for them to establish their own marketplace because the federal resources the ACA made available for them to do this will expire.

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didn’t pick up their prescription medicines due to out-of-pocket costs.

Having access to health insurance plan premiums and coverage options that respond to the needs of women and their families will be a key factor in the success of the exchanges.

Secondly, while the federal law specifies the minimum package of services that must be offered, the specifics of this package of services will be left to each state. Assuring that women and their families truly have access to the full range of preventive services, as well as the other components of the minimum package, will be important to monitor.

While the federal Department of Health and Human Services has deferred to each state to choose a “benchmark plan” to serve as a guide for what must be covered, there is a risk of incomplete or inadequate coverage in some states.

Q. You recently participated in a webinar about the practical considerations of implementing the Affordable Care Act for adolescents and young adults. Would you give us a summary of your key points?

Young adults represent about a third of those without any health insurance. Thus, the ACA has tremendous promise for filling substantial health care delivery gaps. A clear initial success of the ACA has been the enrollment of between 3 million to 6 million young adults up to age 26 on their parents’ health plans; the financial effect of extending coverage to this newly eligible group has been documented as negligible, a mere 0.2 percent increase in overall plan spending.

As a society, we need to recognize that we have often failed to incorporate true preventive services in the delivery of health care. The lack of insurance, combined with risk-taking behaviors, has often resulted in young adults having high rates of emergency room visits – only the very young and the elderly have higher rates.

The major health problems of late adolescence and early adulthood are largely preventable, and many negative health outcomes are linked directly to behavioral decisions. This time period represents a unique opportunity for early intervention with emerging mental health issues, alcohol and tobacco dependence, and obesity, which contribute to chronic health conditions, such as diabetes, heart disease and cancer.

Q. What about the health access of undocumented and legal immigrants?

It is important to note that a substantial proportion of those without health insurance will remain so under the Accountable Care Act, either because they represent undocumented immigrants, or because they are legal immigrants who have lived in the U.S. less than five years.

We are currently conducting a study of a special sub-group of immigrants, known as the Dreamers or DACAs (Deferred Action Childhood Arrivals), to better understand their health care needs, experiences with the health care system and attitudes to health insurance. DACAs have lived in the U.S. at least 5 years, arrived in the U.S. before the age of 16 and who are no older than age 30, and are currently enrolled in school, military or are employed. Initial results point to the need for both physical and mental health services among this population, as well as greater information on how to successfully navigate the health care system. Recently, California’s Medicaid program has been expanded to provide full-scope benefits to eligible, low-income populations, but at this point in time, it is not clear, how many DACAs are aware of their eligibility and whether there have been any barriers in their signing up for these benefits.

In the meantime, immigration law reforms are being debated in Congress and if successful, will have clear implications for the eventual enrollment of these populations in health insurance programs.

Q. How will UCSF health policy experts monitor the impact of the ACA or Covered California?

We are fortunate to have the opportunity to live in California, where many of the ACA elements will be implemented ahead of the country. It is clear that this “road-test” will have many bumps and potentially “near misses,” given the incredible complexity of going to scale with such a multi-pronged policy, with so many moving components.

While initially the focus of policymakers may be on the numbers of covered lives, our UCSF health policy experts will have the opportunity to monitor and evaluate the ACA’s implementation in several key areas.

UCSF researchers will be working with the state to ascertain implementation for the Medicaid population, as well as studying other ramifications, such as workforce issues, meaningful use of electronic health care records in the provision of medical care, the integration of primary care and other systems of care (hospitals, behavioral health, specialty care, etc.) and the conversion of family planning services from a state plan to Medicaid beneficiaries.

"Affordability of care is a key issue for women, who are

disproportionately low income."

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Janet Coffman, PhD, an adjunct professor in the UCSF Department of Family and Community Medicine and the UCSF Philip R. Lee Institute for Health Policy Studies, is an expert on evidence-based medicine and health insurance coverage especially as it relates to prevention and California.

She is the principal analyst for medical effectiveness for the California Health Benefits Review Program, which provides the California State Legislature with data on the medical, cost and public health impacts of proposed health insurance benefit mandates and repeals.

Q: How does the health insurance exchange impact Healthy San Francisco, the city’s program that makes health care services accessible to uninsured San Francisco residents?

Some persons who currently are enrolled in Healthy San Francisco will be eligible for subsidized coverage through Covered California. Others will be eligible to enroll in Medi-Cal under the new eligibility rules. Nevertheless, Healthy San Francisco still will play an important role because some persons enrolled in the program, such as undocumented immigrants, will not be eligible for either Medi-Cal or subsidized coverage through Covered California.

Medi-Cal and Covered California are health insurance; Healthy San Francisco is not. Persons enrolled in Healthy San Francisco who are eligible for Medi-Cal or subsidized coverage through Covered California would benefit from transitioning to these programs because they would have greater choice of providers and would have coverage for more types of medical services. For example, Healthy San Francisco does not pay for care provided outside San Francisco, whereas Medi-Cal and Covered California health plans pay for care provided anywhere in California so long as the provider is in the health plan’s network.

Healthy San Francisco will help eligible enrollees apply for these programs.

ACA's Impact on San Francisco & California

Q: California was the first state to set up an exchange, called Covered California. What are the benefits or downsides to being the nation’s leader?

A major advantage of being the first state to set up an exchange is that California has had more time to plan and implement its exchange. The exchanges are so complex that states need a lot of time to develop them. Establishing the exchange early on also gave California more time to create a governing board, recruit staff and obtain input from consumers, health pans and other stakeholders.

The one downside to being first is that all eyes are on California. Any glitches that consumers experience here may be amplified.

Q: Some of the large insurers, such as Aetna, Cigna and UnitedHealth Group, decided not to sell insurance through Covered California. How do you think that will influence consumer choice?

I do not think the decisions of these health plans will have much impact in California because their market shares are low. Collectively, Aetna, Cigna, and United enroll only 14 percent of Californians with private health insurance and less than 7 percent of persons who have coverage through the individual insurance market.

In contrast, Kaiser Permanente, which enrolls 40 percent of all Californians with private insurance, is offering coverage in 18 of 19 pricing regions in Covered California’s individual exchange and is also participating in its small business exchange. Anthem Blue Cross, Blue Shield of California and HealthNet also are participating in both the individual exchange, and Blue Shield and HealthNet are participating in the small business exchanges.

Q. What do you think California residents need to know about Covered California?

A major advantage of Covered California is that health plans that participate are required to offer standardized health plans, which makes it easier for people to compare plans based on price and provider networks. All health plans sold by Covered California will have to cover the same “essential” health care services. Californians will be able to choose from between two to six health plans, depending on where they live.

Q: Will Californians who keep private insurance see a price increase in their insurance plans because of the exchanges?

Health insurance premiums may rise for some Californians who have private insurance through the individual health insurance market.

Beginning in January 2014, the Affordable Care Act will require that the same rules apply to health insurance sold to

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Josh Adler, MD, is chief medical officer of UCSF Medical Center and UCSF Benioff Children's Hospital. He directs the doctors who provide patient care at UCSF and oversees the quality of medical services and the integration of patient care, education and research.

Adler also oversees care coordination, clinical resource management, compliance, medical staff affairs, quality assurance and risk management. Here, he discusses the Affordable Care Act's (ACA) impact on hospitals and medical practice.

ACA's Impact on Hospitals and Medical

Practice

Q. How will the increase of newly insured consumers impact UCSF Medical Center and UCSF Benioff Children’s Hospital?

We anticipate two important impacts.

First, there likely will be increased demand for care – for emergency and urgent care services, followed by primary and specialty care. Emergency and urgent care services may be the first to be accessed by newly insured people because these will be available immediately upon obtaining insurance, without the need to choose a particular physician or health system and schedule an appointment.

Second, there may be a larger-than-normal percentage of existing UCSF patients who will be changing insurance. The short-term impact will be more complexity for patients and for UCSF staff as patients register for care, and perhaps the need for patients to change medication regimens as drug formularies differ among health plans.

These impacts will be similar in nature for UCSF Benioff Children’s Hospital, although perhaps somewhat smaller in scale because a smaller percentage of California’s children are uninsured and thus fewer will be new to care.

Q. Do you think the exchanges ultimately will improve health outcomes while reducing costs?

This is one of the most important questions to answer regarding the ACA and the public exchanges.

The answer largely depends on the ultimate percentage of patients who obtain insurance through the exchange. If the percentage is substantial, the exchange likely will be able to

individuals and families inside and outside exchanges. This is a major change in California. In the individual market, health plans will no longer be able to deny coverage to anyone or exclude pre-existing conditions from coverage. Health plans will no longer be able to charge sicker people more than healthier people or impose annual or lifetime limits on coverage. They will also have to provide coverage for a comprehensive benefits package.

As a consequence, some younger and healthier persons who currently have individual health insurance that provides only limited benefits may have to pay more for coverage. How much more they will have to pay will depend whether they are eligible for subsidized coverage through Covered California.

"A major advantage of being the first state to set

up an exchange is that California has had more

time to plan and implement its exchange."

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impact costs by applying downward pressure on premiums for any entity offering a plan on the exchange. Impacting quality may also be possible if the exchange is able to require sufficiently transparent measurement and reporting of health outcome metrics, and require minimum levels on health outcomes performance as prerequisites for health care providers to participate in the exchange.

If the exchange does not ultimately represent a large proportion of those insured, its impact on quality and cost will be minimal.

Q. How is UCSF participating in Covered California?

UCSF Medical Center, UCSF Benioff Children’s Hospital and UCSF physicians are part of the network offered by the Anthem Blue Cross health plan offering on the Covered California exchange. This means that patients and families who wish to access UCSF for care via Covered California should choose the Anthem Blue Cross plan.

Of note, all UC Medical Centers and physicians are participating in Covered California in their respective geographic regions via the Anthem Blue Cross plan.

Q. Undocumented immigrants are not eligible for insurance under the exchanges. How will the exchanges impact their access to care?

This is uncertain. Undocumented immigrants will not be able to obtain coverage via the exchanges and thus will largely remain uninsured.

The initial effect may, in fact, be reduced access for the remaining uninsured (including undocumented immigrants) as health systems struggle to meet the demand of the increased insured population. This will be particularly true for scheduled care in physicians’ offices, particularly primary care. If this is correct, then we may see further increases in the use of emergency department utilization for care of late-stage disease.

Q. Do you think there are enough clinicians to handle the influx of newly insured?

Based on the current state and predicted increases in the number of insured Californians, there likely will not be sufficient capacity in the delivery system to meet the demand.

Rural areas will be more impacted than urban, because there already are relative shortages of physicians and, in some cases, hospitals. In all areas, there are likely to be shortages of primary care providers, mental health providers, and general surgeons. Other specialty areas that may have

insufficient capacity include: endocrinology, neurology, and rheumatology. Many emergency departments will experience further overcrowding.

Solutions to remedy these shortages include expanding the primary care workforce. This would include expanding the number of physicians and nurse practitioners available to provide primary care. A complementary approach involves expanding the scopes of practice of nurse practitioners and other health professionals (nurses, pharmacist, psychologists, etc.) who can then assume portions of care now provided only by physicians.

Emergency department overcrowding can be improved through primary care expansion and greater adoption of the primary care medical home model of care in which patients have much easier access to care from their own provider. In addition, expansion of urgent care centers – already occurring in the Bay Area – may provide lower cost alternatives to emergency department care for low acuity health needs.

"Based on the current state and predicted increases in the

number of insured Californians, there likely will not be sufficient capacity in the delivery system

to meet the demand.

Solutions to remedy these shortages include expanding

the primary care workforce.

This would include expanding the number of physicians and

nurse practitioners available to provide primary care."

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New Tobacco Study begins at IHPS

The population of the United States is aging and the number of people in the oldest age groups is rising rapidly. There is also continuing growth in the number of Americans with disabilities. Among

these population groups, health care needs are often substantial and include the need for assistance with activities of daily living (ADLs). Such services are time-intensive and often require continuous care from licensed and unlicensed health care workers. The demand for these services is projected to increase significantly in the coming years.

Joanne Spetz, PhD, Professor, Philip R. Lee Institute for Health Policy Studies and the UCSF school of Nursing, will lead a new center called The UCSF Health Workforce Research Center (UCSF HWRC) The center will be a program of policy-oriented research that will collect, analyze, and report data on issues surrounding the LTC workforce and its impact on high quality, efficient LTC across the nation and within states. The UCSF HWRC will focus on long-term care (LTC) and will examine the supply, demand, distribution, and capacity of the health care workforce to meet LTC needs, both now and in the future. Read more: http://bit.ly/17x1997

Joe Guydish, PhD

Preparing for the Future: Healthcare Workforce Research Center Workforce begins at UCSF.

Joanne Spetz, PhD

Joe Guydish, PhD, Professor in Residence of Medicine, Psychiatry, and Health Policy at the Philip R. Lee Institute for Health Policy Studies, has received a 4-year RO1 grant from the FDA and NIDA to study tobacco use and substance addiction in vulnerable populations. Working with him on this study will be Barbara Tajima, Emma Passalacqua, and Thao Le. About 4 million persons receive addiction treatment annually, and 67-75% of those are also smokers. The FDA has asked for research on these vulnerable populations. Because of their addiction, low income, high smoking rates and social stigma, persons in addiction treatment represent a vulnerable population and are likely to use new tobacco products called potentially modified risk tobacco products (MRTPs). This study will recruit a national sample of treatment programs and interview 1,000 patients per year for each of 3 years. The project will study how FDA communication and tobacco marketing affect risk perception, and the interplay of these factors with changes in tobacco use. Findings will support FDA regulatory efforts to reduce tobacco use in this vulnerable and high-prevalence smoking population.

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Jessica N. Cohan, MD Lindsay A. Hampson, MD

Welcome New Postdoctoral Fellows!

Jessica  Cohan,  MD  and  Lindsay  Hampson,  MD  are  Philip  R.  Lee  Health  Policy  Fellows,  starting  two-­‐year  postdoctoral  fellowships.    Jason  Davies,  Christin  Kearns,  Anna  Pagano,  and  Randy  Uang  are  Institute  Project  Fellows  working  with  Adams  Dudley,  Laura  Schmidt,  Joe  Guydish,  and  Stan  Glantz  respectively.  

Cristin Kearns, DDS, MBA

Jason Davies, MD, PhD

Randy Uang, PhD Anna Pagano, PhD

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When & Where?

GHECon

Friday, November 22, 2013 from 9:00 AM to 5:00 PM (PST)

Location: 1650 Owens St San Francisco, CA

For more information:

globalhealthsciences.ucsf.edu/ghecon

email: GHEcon@ucsf.edu

Twitter: #GHECon

Global Health Economics Consortium (GHECon) Launch

As part of the GHECon launch, we are planning a one-day inaugural colloquium on November 22 to assemble faculty, staff, and students from UCSF interested in global health economics -- the economists, and the clinical researchers and others who would like to collaborate with economists. We are also inviting colleagues with similar interests from UCB and Stanford. The agenda includes a keynote talk by Dr. Stefano Bertozzi (the new Dean of the UCB School of Public Health) on the role of economics in global health; case studies of health economics projects conducted at UCSF; issues surrounding the development of health economics research projects; hands-on training workshops; networking events; and a panel discussion on the report of the Commission on Investing in Health.

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Bardach NS, Wang JJ, De Leon SF, Shih SC, Boscardin WJ, Goldman LE, Dudley RA. Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA. 2013 Sep 11;310(10):1051-9. doi: 10.1001/jama.2013.277353.

Bardach NS, Vittinghoff E, Asteria-Peñaloza R, Edwards JD, Yazdany J, Lee HC, Boscardin WJ, Cabana MD, Dudley RA. Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics. 2013 Sep;132(3):429-36. doi: 10.1542/peds.2012-3527.

Belkora J, Miller M, Crawford B, Coyne K, Stauffer M, Buzaglo J, Blakeney N, Michaels M, Golant M. Evaluation of question-listing at the Cancer Support Community. Translational Behavioral Medicine 2013 Jun;3(2):162-71. doi: 10.1007/s13142-012-0186-8. Biggs MA, Arons A, Turner R, Brindis CD. Same-day LARC insertion attitudes and practices. Contraception. 2013 Nov;88(5):629-35. doi: 10.1016/j.contraception.2013.05.012.

Bindman AB, Blum JD, Kronick R. Medicare payment for chronic care delivered in a patient-centered medical home. JAMA. 2013 Sep 18;310(11):1125-6. doi: 10.1001/jama.2013.276525.

Bozic KJ, Belkora J, Chan V, Youm J, Zhou T, Dupaix J, Bye AN, et al. Shared decision making in patients with osteoarthritis of the hip and knee: results of a randomized controlled trial. The Journal of Bone & Joint Surgery. 2013 Sep 18;95(18):1633-9. doi: 10.2106/JBJS.M.00004.

Brownell J, Wang J, Smith A, Stephens C, Hsia RY. Trends in Emergency Department Visits for Ambulatory Care Sensitive Conditions by Elderly Nursing Home Residents, 2001 to 2010. JAMA Internal Medicine. 2013 Oct 28. doi: 10.1001/jamainternmed.2013.11821.

Campbell BK, Buti A, Fussell HE, Srikanth P, McCarty D, Guydish JR. Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation. The American Journal of Drug and Alcohol Abuse. 2013 Sep;39(5):304-11. doi: 10.3109/00952990.2013.799175.

Cannon CP, Brindis RG, Chaitman BR, Cohen DJ, Cross JT Jr, et al. 2013 ACCF/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Acute Coronary Syndromes and Coronary Artery Disease Clinical Data Standards). Critical Pathways in Cardiology. 2013 Jun;12(2):65-105. doi: 10.1097/HPC.0b013e3182846e16.

Carroll JD, Edwards FH, Marinac-Dabic D, Brindis RG, Grover FL, Peterson ED, et al. The STS-ACC transcatheter valve

therapy national registry: a new partnership and infrastructure for the introduction and surveillance of medical devices and therapies. The Journal of the American College of Cardiology. 2013 Sep. 10;62(11):1026-34. doi: 10.1016/j.jacc.2013.03.060.

Casalino LP, Wu FM, Ryan AM, Copeland K, Rittenhouse DR, Ramsay PP, Shortell SM. Independent practice associations and physician-hospital organizations can improve care management for smaller practices. Health Affairs (Millwood). 2013 Aug;32(8):1376-82. doi: 10.1377/hlthaff.2013.0205.

Danesh M, Belkora J, Volz S, Rugo HS. Informational Needs of Patients with Metastatic Breast Cancer: What Questions Do They Ask, and Are Physicians Answering Them? Journal of Cancer Education. 2013 Oct 19.

Edwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA. Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs. Critical Care Medicine. 2013 Aug 26.

Fogel RI, Epstein AE, Estes NA 3rd, Lindsey BD, Dimarco JP, Kremers MS, Kapa S, Brindis RG, Russo AM. The Ultimate Dilemma - The Disconnect Between the Guidelines, the Appropriate Use Criteria and Reimbursement Coverage Decisions. The Journal of the American College of Cardiology. 2013 Jul 20. doi:pii: S0735-1097(13)02824-6. 10.1016/j.jacc.2013.07.016.

Foster DG, Biggs MA, Malvin J, Bradsberry M, Darney P, Brindis CD. Cost-savings from the provision of specific contraceptive methods in 2009. Womens Health Issues. 2013 Jul-Aug;23(4):e265-71. doi: 10.1016/j.whi.2013.05.004.

Gerona RR, Woodruff TJ, Dickenson CA, Pan J, Schwartz JM, Sen S, Friesen MW, Fujimoto VY, Hunt PA. Bisphenol-A (BPA), BPA Glucuronide, and BPA Sulfate in Midgestation Umbilical Cord Serum in a Northern and Central California Population. Environmental science and technology. 2013 Nov 5;47(21):12477-85. doi: 10.1021/es402764d.

Gershon RR, Kraus LE, Raveis VH, Sherman MF, Kailes JI. Emergency preparedness in a sample of persons with disabilities. American Journal of Disaster Medicine. 2013 Winter;8(1):35-47. doi: 10.5055/ajdm.2013.0109.

Grewal SK, Haas AF, Pletcher MJ, Resneck JS Jr. Compliance by California tanning facilities with the nation's first statewide ban on use before the age of 18 years. Journal of the American Academy of Dermatology. 2013 Oct 10. doi:pii: S0190-9622(13)00967-5. 10.1016/j.jaad.2013.09.016.

Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE Jr, Burke JA, Dehmer GJ, Deychak YA, Jneid H, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac

Recent Publications

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interventional procedures). Circulation. 2013 Jul 23;128(4):436-72. doi: 10.1161/CIR.0b013e318299cd8a. 2013 May 8. Herring AA, Johnson B, Ginde AA, Camargo CA, Feng L, Alter HJ, Hsia R. High-intensity emergency department visits increased in california, 2002-09. Health Affairs. (Millwood). 2013 Oct;32(10):1811-9. doi: 10.1377/hlthaff.2013.0397.

Himmelstein J, Bindman AB. Advancing the university mission through partnerships with state medicaid programs. Academic Medicine. 2013 Nov;88(11):1606-8. doi: 10.1097/ACM.0b013e3182a7cdf8.

Hsu RK, McCulloch CE, Ku E, Dudley RA, Hsu CY. Regional variation in the incidence of dialysis-requiring AKI in the United States. The Clinical Journal of the American Society of Nephrology. 2013 Sep;8(9):1476-81. doi: 10.2215/CJN.12611212.

Hughes D, Docto L, Peters J, Lamb AK, Brindis C. Swimming upstream: the challenges and rewards of evaluating efforts to address inequities and reduce health disparities. Eval Program Plann. 2013 Jun;38:1-12. doi: 10.1016/j.evalprogplan.2013.01.004.

Ishida JH, McCulloch CE, Dudley RA, Grimes BA, Johansen KL. Dialysis facility profit status and compliance with a black box warning. JAMA Internal Medicine. 2013 Jun 24;173(12):1152-3. doi: 10.1001/jamainternmed.2013.979. Jacobs DB, Greene M, Bindman AB. It's academic: public policy activities among faculty members in a department of medicine. Acad Med. 2013 Oct;88(10):1460-3. doi: 10.1097/ACM.0b013e3182a37329.

Kahn JG, Marseille EA. Viral load monitoring for antiretroviral therapy in resource-poor settings: an evolving role. AIDS. 2013 Jun 1;27(9):1509-11. doi: 10.1097/QAD.0b013e3283617544.

Ko M, Bindman AB. No man is an island: disentangling multilevel effects in health services research. BMJ Qual Saf. 2013 Nov 7. doi: 10.1136/bmjqs-2013-002591.

Krauth D, Woodruff TJ, Bero L. Instruments for assessing risk of bias and other methodological criteria of published animal studies: a systematic review. Environmental Health Perspectives. 2013 Sep;121(9):985-92. doi: 10.1289/ehp.1206389.

Kurian AW, Mitani A, Desai M, Yu PP, Seto T, Weber SC, Olson C, Kenkare P, Gomez SL, de Bruin MA, Horst K, Belkora J, et al. Breast cancer treatment across health care systems: Linking Electronic Medical Records and State Registry Data to Enable Outcomes Research. Cancer. 2013 Sep 24. doi: 10.1002/cncr.28395.

Lewis RC, Gershon RR, Neitzel RL. Estimation of permanent noise-induced hearing loss in an urban setting. Environmental Science and Technology. 2013 Jun 18;47(12):6393-9. doi: 10.1021/es305161z.

Lim HW, Resneck JS Jr, Fischoff R. Research agenda consensus conference. Journal of the American Academy of Dermatology. 2013 Aug;69(2):294. doi: 10.1016/j.jaad.2013.04.004.

Lin GA. Patient education: one size does not fit all. JAMA Internal Medicine. 2013 Jul 22;173(14):1376. doi: 10.1001/jamainternmed.2013.7402.

Malone RE. 'A brave but vital initiative': reining in corporate harm. Tobacco Control. 2013 Jul;22(4):217. doi: 10.1136/tobaccocontrol-2013-051153.

McClellan SR, Casalino LP, Shortell SM, Rittenhouse DR. When does adoption of health information technology by physician practices lead to use by physicians within the practice? JAMIA. 2013 Jun;20(e1):e26-32. doi: 10.1136/amiajnl-2012-001271.

McCuistion MH, Stults CD, Dohan D, Frosch DL, Hung DY, Tai-Seale M. Overcoming Challenges to Adoption of Shared Medical Appointments. Population Health Management. 2013 Oct 24. doi:10.1089/pop.2013.0035.

Michtalik HJ, Pronovost PJ, Marsteller JA, Spetz J, Brotman DJ. Developing a model for attending physician workload and outcomes. JAMA Internal Medicine. 2013 Jun 10;173(11):1026-8. doi: 10.1001/jamainternmed.2013.405.

Moynihan RN, Cooke GP, Doust JA, Bero L, Hill S, Glasziou PP. Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Medicine. 2013 Aug;10(8):e1001500. doi: 10.1371/journal.pmed.1001500.

Neltner TG, Alger HM, O'Reilly JT, Krimsky S, Bero LA, Maffini MV. Conflicts of Interest in Approvals of Additives to Food Determined to Be Generally Recognized as Safe: Out of Balance. JAMA Internal Medicine. 2013 Aug 7. doi: 10.1001/jamainternmed.2013.10559.

Newgard CD, Kuppermann N, Holmes JF, Haukoos JS, Wetzel B, Hsia RY, Wang NE, Bulger EM, Staudenmayer K, Mann NC, Barton ED, Wintemute G; WESTRN Investigators. Gunshot injuries in children served by emergency services. Pediatrics. 2013 Nov;132(5):862-70. doi: 10.1542/peds.2013-1350.

Offen N, Smith E, Malone RE. Offen et al. respond. American Journal of Public Health. 2013 Jul;103(7):e3-4. doi: 10.2105/AJPH.2013.301388.

Omachi TA, Gregorich SE, Eisner MD, Penaloza RA, Tolstykh IV, Yelin EH, Iribarren C, Dudley RA, Blanc PD. Risk adjustment for health care financing in chronic disease: what are we missing by failing to account for disease severity? Medical Care. 2013 Aug;51(8):740-7. doi: 10.1097/MLR.0b013e318298082f.

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Fall 2013 http://healthpolicy.ucsf.edu

Petersen LA, Simpson K, Pietz K, Urech TH, Hysong SJ, Profit J, Conrad DA, Dudley RA, Woodard LD. Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA. 2013 Sep 11;310(10):1042-50. doi: 10.1001/jama.2013.276303.

Ratanawongsa N, Barton JL, Schillinger D, Yelin EH, Hettema JE, Lum PJ. Ethnically Diverse Patients' Perceptions of Clinician Computer Use in a Safety-net Clinic. Journal of health care for the poor and underserved. 2013;24(4):1542-51. doi: 10.1353/hpu.2013.0188.

Redberg RF. All Placebos Are Not Created Equally. JAMA Internal Medicine. 2013 Oct 14. doi: 10.1001/jamainternmed.2013.8544.

Redberg RF. Choosing Wisely, and Soon. JAMA Internal Medicine. 2013 Oct 3. doi: 10.1001/jamainternmed.2013.11672.

Redberg RF. My thyroid story. JAMA Internal Medicine. 2013 Oct 28;173(19):1769. doi: 10.1001/jamainternmed.2013.9279. Rhoads KF, Ngo JV, Ma Y, Huang L, Welton ML, Dudley RA. Do hospitals that serve a high percentage of Medicaid patients perform well on evidence-based guidelines for colon cancer care? Journal of Health Care for the Poor and Underserved. 2013 Aug;24(3):1180-93. doi: 10.1353/hpu.2013.0122.

Rhoads KF, Ackerson LK, Ngo JV, Gray-Hazard FK, Subramanian SV, Dudley RA. Adequacy of Lymph Node Examination in Colorectal Surgery: Contribution of the Hospital Versus the Surgeon. Medical Care. 2013 Aug 21. Rittenhouse DR, Schmidt LA, Wu KJ, Wiley J. Incentivizing Primary Care Providers to Innovate: Building Medical Homes in the Post-Katrina New Orleans Safety Net. Health Services Research. 2013 Jun 26. doi: 10.1111/1475-6773.12080. Sanders-Jackson AN, Song AV, Hiilamo H, Glantz SA. Effect of the framework convention on tobacco control and voluntary industry health warning labels on passage of mandated cigarette warning labels from 1965 to 2012: transition probability and event history analyses. The American Journal of Public Health. 2013 Nov;103(11):2041-7. doi: 10.2105/AJPH.2013.301324.

Sanders-Jackson A, Gonzalez M, Zerbe B, Song AV, Glantz SA. The pattern of indoor smoking restriction law transitions, 1970-2009: laws are sticky. The American Journal of Public Health. 2013 Aug;103(8):e44-51. doi: 10.2105/AJPH.2013.301449.

Schamber EM, Takemoto SK, Chenok KE, Bozic KJ. Barriers to completion of patient reported outcome measures. Journal of Arthroplasty. 2013 Oct;28(9):1449-53. doi: 10.1016/j.arth.2013.06.025.

Spetz J, Kovner CT.How can we obtain data on the demand for nurses? Nursing Economics. 2013 Jul-Aug;31(4):203-7.

Spetz J, Gates M, Jones CB. Internationally educated nurses in the United States: Their origins and roles. Nursing Outlook. 2013 Jun 26. doi: pii: S0029-6554(13)00100-0. 10.1016/j.outlook.2013.05.001.

Spetz J. The research and policy importance of nursing sample surveys and minimum data sets. Policy, Politics, & Nursing Practice. 2013 Feb;14(1):33-40. doi: 10.1177/1527154413491149.

Spetz J, Bates T. Is a Baccalaureate in Nursing Worth It? The Return to Education, 2000-2008. Health Services Research. 2013 Sep 16. doi: 10.1111/1475-6773.12104. Staudenmayer KL, Hsia RY, Mann NC, Spain DA, Newgard CD.Triage of elderly trauma patients: a population-based perspective. Journal of the American College of Surgeons. 2013 Oct;217(4):569-76. doi: 10.1016/j.jamcollsurg.2013.06.017.

Sutton P, Woodruff TJ. Risk communication and decision tools for children's health protection. Birth defects research. Part C, Embryo today. 2013 Mar;99(1):45-9. doi: 10.1002/bdrc.21029.

Welch WP, Cuellar AE, Stearns SC, Bindman AB. Proportion of physicians in large group practices continued to grow in 2009-11. Health Affairs (Millwood). 2013 Sep;32(9):1659-66. doi: 10.1377/hlthaff.2012.1256.

Wu AK, Elliott P, Katz PP, Smith JF. Time costs of fertility care: the hidden hardship of building a family. Fertility and Sterility. 2013 Jun;99(7):2025-30. doi: 10.1016/j.fertnstert.2013.01.145.

Wu AK, Odisho AY, Washington SL 3rd, Katz PP, Smith JF. Out-of-Pocket Fertility Patient Expense: Data from a Multicenter Prospective Infertility Cohort. The Journal of Urology. 2013 Sep 7. doi:pii: S0022-5347(13)05330-5. 10.1016/j.juro.2013.08.083.

Yerger VB, Cataldo JK, Malone RE. Older smokers could be the strongest supporters for U.S. government regulation of tobacco: a focus group study. Tobacco induced diseases. 2013 Aug 17;11(1):17. doi: 10.1186/1617-9625-11-17.

Zarin-Pass M, Belkora J, Volz S, Esserman L. Making Better Doctors: A Survey of Premedical Interns Working as Health Coaches. Journal of Cancer Education. 2013 Oct 28.

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Fall 2013 http://healthpolicy.ucsf.edu

Sugar Industry's Secret Documents Echo Tobacco Tactics Cristin Kearns, DDS, MBA, a postdoctoral fellow at PRL-IHPS has found what food industry critics have been seeking for years — documents suggesting that the sugar industry

used Big Tobacco tactics to deflect growing concern over the health

effects of sugar.

"I had lists of their board reports, their financial statements, I had names of their scientific

consultants, I had a list of research projects they funded, and

I had these memos where they were describing how their PR men should

handle conflict of interest questions from the press," she says.

The documents survived in the Colorado University Library Archives only because they helped explain a photograph of three men and a trophy. When the Great West Sugar Company went out of business in the 1980s, someone put the files in a box so that librarians would know who the men were and why they were being honored. So who were they?

Read more: http://bit.ly/1dvS7Yu

Will Paying Doctors for Performance Improve Patient Outcomes? - Naomi Bardach, MD Paying doctors for performing specific medical procedures

and examinations has traditionally been the “fee for service” model, where

everyone gets paid a set amount regardless of quality or patient outcomes.

What would happen if doctors were paid based on how well they

performed? That’s the question researchers at UC San Francisco

and the New York City Department of Health and Mental Hygiene asked in a study published in the Journal of the American Medical Association (JAMA). Read more: http://bit.ly/HPua3X

Janet Coffman, PhD leads new Project Partnership with Center for the Health Professions and PRL-IHPS The Center for the Health Professions (the Center) and the Philip R. Lee Institute for Health Policy Studies (IHPS) have recently partnered to provide technical assistance in the development and evaluation of an innovative program designed to test “Community Paramedicine.” in California. Working with the California Office of Statewide Health Planning and Development’s (OSHPD) Health Workforce Pilot Projects (HWPP), the California Emergency Medical Services Authority (EMSA) will conduct several projects across the state testing new models health care delivery by EMT-Ps trained to provide services beyond their customary roles in emergency response and transport. Janet Coffman, PhD, of IHPS, will be the project’s Principal Investigator, and researcher Cynthia Wides, MA, of the Center, will serve as the Project Director. Susan Chapman, PhD, Faculty Affiliate, and Catherine Dower, JD, Health Policy and Law Director, at the Center are also collaborating on this exciting project. Read more: http://futurehealth.ucsf.edu

Research & Honors Spotlight

Steven Schroeder, MD, Receives Institute of Medicine's 2013 Lienhard Award

The Institute of Medicine presented the 2013 Gustav O. Lienhard Award to Steven A. Schroeder, MD, whose pioneering efforts to control tobacco use have helped save millions from premature, smoking-related deaths. The award recognizes Schroeder's leadership in general medicine as well as his work to improve end-of-life care. Steven is also chairman of the Philip R. Lee Institute for Health Policy Studies' National Advisory Committee. Philip R. Lee was a previous recipient of the Gustav O. Lienhard Award. Read more: http://bit.ly/H4Y6bP

15

Fall 2013 http://healthpolicy.ucsf.edu PRL- IHPS in the News

Can There Be Too Much Choice in Health Insurance?

Traditional economic theory asserts that more choice is better. It unleashes competitive forces; consumers can simply ignore choices that are not optimal. But can there be too much choice?

Presented by Thomas Rice, PhD Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health - Watch video: http://youtu.be/JPp1hu4uguA

"The ACC National Cardiovascular Data Registry."

"The ACC National Cardiovascular Data Registry." Ralph G. Brindis, M.D., American College of Cardiology, ACE Director Clinical

Professor of Medicine, Department of Medicine & the Philip R. Lee Institute for Health Policy Studies, UCSF, SF Medicine Vol 86 Oct 2013. pp. 18-19

- Read more: http://issuu.com/sfmedsociety/docs/october_27632fdab75e45/19?e=3533752/5331817

SF Medicine, October 2013: "The Promise of Big Data."

"The Promise of Big Data - The DNA of Population and Clinical Data." Claire Brindis, DrPH, Director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. SF Medicine Vol 86 Oct 2013. pps. 14-15

- Read more: http://issuu.com/sfmedsociety/docs/october_27632fdab75e45/15?e=3533752/5331817

Video: Improving the Health, Safety and Well-Being of Young Adults

"Report Back from Institute of Medicine Meeting Improving the Health, Safety and Well-Being of Young Adults" Claire Brindis, Dr.P.H., Professor in the Department of Pediatrics, UCSF and Director of the Philip R. Lee Institute for Health Policy Studies presents at the inaugural CVP Seminar. http://cvp.ucsf.edu

- Watch video: http://youtu.be/yxbm88CtrYk

Curbing the Cost of Health Care in the U.S.

"Physician Network on Health Care Costs: Consensus Themes and Recommendations." 18 National Physicians including UCSF's Kevin Bozik and Rita Redberg provide surprisingly frank ways to curb the cost of health care in the U.S.

- Read more: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf408297

Podcast: How Will the ACA and Health Reform Make Us Healthier?

How might the Affordable Care Act and health reform make us healthier? A group of experts, including Andrew Bindman, MD, Professor of Medicine and Health Policy at PRL-IHPS, UCSF, discuss how the different aspects of the law may impact patient health. (NPR Podcast)

- Read more: http://www.npr.org/2013/10/11/232159374/health-reform-and-healthier-outcomes

Californians Prepare for Increase in Medical Insurance Costs

Californians who purchase their own health insurance are bracing to pay more for medical insurance premiums. Janet Coffman, PhD, professor at PRL-IHPS, UCSF notes that insurance cost is one of many areas in which the impact of the health care law on individuals and families can vary widely.

- Read more: http://healthpolicy.ucsf.edu/news-events/news#sthash.D6Ll4KxU.dpuf

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Fall 2013 http://healthpolicy.ucsf.edu

Webcast: "Let Girls Lead"

"Let Girls Lead" World Affairs Council, San Francisco. Panel featuring global experts working to advance girls’ health, education and well being. Speaker(s) Riya Singh, Elizabeth Gore, Denise Dunning, and Claire Brindis.

- Watch Video: http://youtu.be/lGFBwZFnL8Q

Strengthening California's Health Care Safety Net - Updated!

The Philip R. Lee Institute for Health Policy Studies at UCSF, announces a collection of research briefs from UC Berkeley and UCLA describing the impact of health care reform on providers serving low-income populations in California, as well as a clinic financial primer from UCSF.

- Read more: http://bit.ly/SoDj63 Clinical trial eyes dissolving coronary stents A new Japanese coronary stent device completely dissolves into the artery wall and leaves behind no permanent foreign material, reducing the likelihood of an in-stent blood clot. Dr. Ralph Brindis, MD, MPH, MACC, believes that advances in stent procedures and surgery have helped save many patients' lives.

- Read more: http://bit.ly/GHzQNm

Obamacare impact: More patients, more health care jobs

In New Jersey, experts estimate that hundreds of thousands of will be added to the insurance rolls under the ACA, increasing the need for health care specialists. “When people have health insurance, they demand more health care services,” says Joanne Spetz, PhD, Professor, PRL-IHPS, UCSF.

- Read more: http://bit.ly/18QTTyy

To Grow Healthier Kids, Just Add Water

Legislation passed in California has led to school districts improving drinking water facilities in schools. A study by Dr. Anisha Patel, MD, UCSF concluded that sugary drinks, like sodas and sports drinks, are a large driver of the obesity epidemic, contributing countless empty calories to our diets.

- Read more: http://huff.to/180CHqw

Economics Professor Offers Advice To Teach At University Level

Joanne Spetz, PhD, Professor of Economics at PRL-IHPS UCSF, offers expert advice for individuals interested in a career in education, particularly for those hoping to teach at the university level.

- Read more: http://cbsloc.al/1aEBclP

Webcast: Implementing the ACA for Adolescents & Young Adults

Webcast Presentations by Claire D. Brindis, DrPH, Amy Lin, MPA and Rachel A. Samsel, MSSW. Topics Presented: "Confidentiality in health care for adolescents and young adults", "Young adults and the Affordable Care Act" and "Providing for the needs of adolescents and young adults."

-Watch archived webcast: http://1.usa.gov/1boWBlU

CathPCI: ACC’s Flagship Registry Leading Registry Innovation

Ralph G. Brindis, MD, MPH, MACC, describes CathPCI: "Once health plans and local initiatives converted to using CathPCI as a platform, people began to take notice, since typically the information being captured at local levels was without consistent data definitions." - Read more: http://bit.ly/17Loa3y

Heart Stents Still Overused, Experts Say

Heart stents continue to be implanted in patients with little if any benefit. Dr. Grace Lin, MD, MAS, associate professor of medicine and health policy at UCSF believes many primary care physicians and cardiologists who see a blockage and open it, think it must help in some way even if the data suggest otherwise.

- Read more: http://nyti.ms/1bIHh09

Donor Nucleic Acid Testing: A Cost-Effectiveness Analysis

James Kahn MD, MPH: Study of the cost-effectiveness of DNA amplification testing to identify solid organ donors recently infected with HIV or hepatitis C. With low test costs and high risk of disease, nucleic acid testing was costly for HIV, and for HepC money was saved by avoiding expensive disease.

- Read more: http://bit.ly/17CUrMh

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Fall 2013 http://healthpolicy.ucsf.edu

Jeff Belkora's Group:

Erika Cagampan Kevin Chang Megan Eaves Jessica Forino Rajika Jindani Kim Jung-Joo

Devon Johnson Mithila Kareti Chloe Kiester

Joleysa Manese Sabrina Marques

Emily Schwab Margarita Shust

(cont'd):

Edward Wang Lauren Rene-Ward

Tia Weinberg Xiteng Yan

Pete Yeh Anna Young Biqi Zhang

Dan Dohan's Group:

Lizi Feng

Gladis Chavez

Robyn Gershon's Group:

Ezinne Nwankwo Kirsten Roberston

Research Analysts

Laurie Jacobs Sarah Leff

David Lowe Maria Gonzalez-Vargas

Statistician

Sam Tseng

New Additions To PRL-IHPS

(One year or less)

Welcome!

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Fall 2013 http://healthpolicy.ucsf.edu

Clarissa Kowalski Born July 18th, 19 inches, 6.5 pounds!

Parents: Devon and Gary

Leo Yarger Born August 26th, 20.5 inches, 8.9 pounds!

Parents: Jennifer and Steven

Juliette Chen Born October 17th, 19.75 inches, 7.5 pounds!

Parents: Catherine and Justin

New Family!

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Fall 2013 http://healthpolicy.ucsf.edu

A New Chapter ... g Dr. Cristina Martinez will be returning to Spain in December after completing her tenure at PRL-IHPS. She is a Postdoctoral Fellow at the Philip R. Lee Institute for Health Policy Studies at UCSF. Cristina received an award from the Spanish Government for health policy research in tobacco control and has been working with Dr. Joe Guydish on tobacco control interventions among vulnerable populations. Before coming to UCSF, Cristina was working in health care program implementation to maximize tobacco control in health care services, and represented the Catalan Institute of Oncology (ICO) in Catalonia. At ICO, she coordinated two projects: the Catalan Network for Tobacco-Free Health Care Services and the Global Network for Tobacco-free Health Care Services for 8 years. Dr. Martinez is a native of Spain (from Barcelona) and has a Doctoral Degree in Clinical Science (University of Barcelona) and has a Master's Degree in Social Anthropology with a Specialization in Health Policy (UCSF).

Sarah Zheng is a medical student who was awarded a Jon Showstack Career Advancement fellowship. For her project, Sarah examined the Humanitarian Device Exemption pathway for approving high-risk medical devices.

Rachel Siemons is also a UCSF medical student who was a Philip R. Lee Health Policy Fellow with us during the summer. Rachel's project related to health care access and needs of young Latino immigrants in California under the Deferred Action for Childhood Arrivals (DACA) initiative. Kelsey Lythcott, a research analyst at PRL-IHPS, will be taking a position at UCSF Benioff Children's hospital in November. At PRL-IHPS, Kelsey was involved in the planning and execution of focus groups, leading interviews, and development of data collection tools for an evaluation, and for a project to improve services for families with children that have special health care needs.

http://healthpolicy.ucsf.edu Fall 2013

Upcoming Events Chancellor's Health Policy Lecture George C. Halvorson Chairman, Kaiser Permanente (until recently Chairman and CEO)

Wednesday, January 29, 2014 12 noon in Cole Hall

John Eisenberg Legacy Lecture David Mechanic, PhD Founding Director Institute for Health, Health Care Policy and Aging Research Rutgers University

Thursday, February 6, 2014 3:00 pm at Parnassus campus

Philip R. Lee Institute for Health Policy Studies 3333 California Street, Suite 265 San Francisco, CA 94118 http://heathpolicy.ucsf.edu