Blog: The View from Here

  • Why Can’t We Be Friends? The Challenge of Public-Private Collaborations that Improve Health Care

    May 20, 2015 | Christopher F. Koller, President

    State health policymakers face more work than they can handle now. Delivery system reform. Medicaid sustainability and expansion. Affordable Care Act (ACA) implementation. The latest public health issue. Angry constituents. When can they collaborate with private sector leaders working on some of the same issues? The Fund, with the help of the Network for Regional Health Improvement, recently … Read more

  • No Longer Trying to Have it Both Ways: Measuring Total Health Care Costs

    Apr 15, 2015 | Christopher F. Koller, President

    Welcome to health care’s economic wonderland: “Health care costs are killing employers and the government budget.” “Health care jobs are the key to our economic recovery.” “We want to lure more high-paying biotech jobs into our community.” These contradictory statements often peacefully coexist in the magical reality of this wonderland. When I was health insurance … Read more

  • Keeping Lives Safe: the Australian Way

    Mar 12, 2015 | Christopher F. Koller, President

    Along the coast of Australia, every community has its own Surf Life-Saving Club (SLSC), a voluntary club that trains and certifies residents to patrol the beaches. Most have their own building overlooking the surf—and get some support from the local municipality, akin to our voluntary fire departments. SLSCs are ubiquitous—especially on crowded suburban beaches. SLSC members walk around the … Read more

  • Transforming Primary Care: The March Continues

    Feb 2, 2015 | Christopher F. Koller, President

    Improving population health by building more and better primary care in the United States might be considered an exercise in what a nun I once met called, “the theology of the long haul.” I am not sure we have God on our side here, but we do have evidence—much of it published in The Milbank Quarterly by research titans like Barbara Starfield. The evidence is clear—the foundation of any high … Read more

  • “Doing Population Health”: Teaching a Pig to Sing?

    Jan 28, 2015 | Christopher F. Koller, President

    “Don’t try to teach a pig to sing, Chris,” a colleague once advised me, quoting the well-known saying. “You won’t succeed and you will only tick off the pig.” The image of singing swine seems particularly apt right now as we look at the question of whether medical providers can practice “population health.” A recent op-ed in The Milbank Quarterly and presentations about community health and … Read more

  • What’s on the Minds of the States?

    Dec 19, 2014 | Christopher F. Koller, President

    Put a bunch of state leaders in a room, kick out the hangers-on, close the door, and ask them where they need help in health policy. What do they say? This is not a hypothetical question. The Milbank Memorial Fund did just that for three weeks in a row last month. And the responses were illuminating. The occasion was the fall meetings of the Fund’s Reforming States Group (RSG), a group with a … Read more

  • Ebola Mania and the Reality of Uncertainty

    Nov 25, 2014 | Christopher F. Koller, President

    For state leaders, Ebola has been a “Pac-Man” issue—inexorably gobbling up resources and time and, like the disease itself, constantly threatening to break out of control. The public health response to the outbreak of a new and life-threatening infectious disease is complex; it involves unclear authority, necessitates changing policy responses, and guarantees lots of media attention. All in … Read more

  • Sovaldi Redux – The States Muddle Through

    Oct 16, 2014 | Christopher F. Koller, President

    What kind of coverage decisions are states making about Sovaldi, the new Hepatitis C drug that costs $1,000 a pill or up to $168,000 a treatment? The drug presents new hope for patients, but grave risks to Medicaid and state corrections budgets, both of which must pay for care for a disproportionate number of people with Hepatitis C. Drugs like Sovaldi—and there are more like it on the … Read more

  • Transforming Delivery Systems—It’s All About Alignment

    Sep 1, 2014 | Christopher F. Koller, President

    How does systemic restructuring happen in health care delivery systems? It’s a given among the health policy intelligentsia that to improve the value of health care in the United States, delivery systems need to “restructure”—to change the people, technology, and processes used to provide medical care. The conventional wisdom is that this restructuring is an even bigger policy challenge than … Read more

  • Learning Chinese

    Aug 1, 2014 | Christopher F. Koller, President

    “Physicians at my hospital are retiring. Younger doctors are exploring opportunities in other regions where they can make more money. I can’t recruit new physicians. If my rates from payers don’t improve, I won’t have any providers to see patients.” When I was Health Insurance Commissioner in Rhode Island reviewing proposed rate increases from insurers, I regularly heard complaints like these. … Read more