Saturday, January 27, 2018

Pope Francis in Chile

Thirty years after the pastoral trip of St. Pope John Paul II to Chile, the current Pope Francis undertook his sixth visit to Latin America, this time visiting Chile and Peru (between January 15 and January 22) during different historical, social, and political circumstances, that are always changing, of course. On the last papal visit in 1987, for example, Chile was under the military and dictatorial regime of Pinochet. Today, Chile lives in a regime of democratic government.

Enlightening the minds and hearts of men and women of good will, Pope Francis, in his mission and style, confirms and encourages the faith of Catholics, and helps clarify - by the light of the Gospel of Jesus Christ - today's problems, of the men and the peoples he visits. He presented the Good News of Jesus with current themes, very near and very close to the feelings and the deepest, most intimate, and most current experiences and urgencies of the life of each audience.

With the emotion of a Catholic and with the pride of being Chilean, with the fresh joy of the encounter with Francis and with gratitude to God for the privilege of having been present in this Apostolic Journey as a special guest of the Chilean government, let me emphasize here, very briefly, the thoughts, the themes, the strong ideas, and the most important moments, of the speeches delivered by Pope Francis to the Chilean people, transcribing his very words to preserve them - just as they were delivered, without interpreting them or changing them, for our reflection and Christian life.

At the MEETING WITH THE AUTHORITIES, THE CIVIL SOCIETY AND THE DIPLOMATIC CORPS at the Palacio de la Moneda in Santiago de Chile on Tuesday, January 16, 2018, the Pope reminded all Chileans of the challenge that should enliven the days of this Nation in its present and near future: "a great and exciting challenge: to continue working to make this democracy, as your forebears dreamed, beyond its formal aspects, a true place of encounter for all. To make it a place where everyone, without exception, feels called to join in building a house, a family and a nation. A place, a house and a family called Chile: generous and welcoming, enamored of her history, committed to social harmony in the present, and looking forward with hope to the future. Here we do well to recall the words of Saint Alberto Hurtado: “A nation, more than its borders, more than its land, its mountain ranges, its seas, more than its language or its traditions, is a mission to be fulfilled.”  It is a future. And that future depends in large part on the ability of its people and leaders to listen.”’ And, added the Pope: to especially listen: 

  •  “TO THE UNEMPLOYED, who cannot support the present, much less the future of their families;
  •  TO THE NATIVE PEOPLES, often forgotten, whose rights and culture need to be protected lest that part of this nation’s identity and richness be lost;
  •  TO THE MIGRANTS, who knock on the doors of this country in search of a better life, but also with the strength and the hope of helping to build a better future for all;
  •  TO YOUNG PEOPLE, and their desire for greater opportunities, especially in education, so that they can take active part in building the Chile they dream of, while at the same time shielding them from the scourge of drugs that rob the best part of their lives;
  • TO THE ELDERLY, with their much-needed wisdom and their particular needs. We cannot abandon them. 
  • TO THE CHILDREN, who look out on the world with eyes full of amazement and innocence, and expect from us concrete answers for a dignified future.”

And, at this moment of his intervention, Pope Francis added a request for forgiveness that was very just, necessary, and anticipated by the Chilean people in this Apostolic Visit: "Here I feel bound to express my pain and shame, shame at the irreparable damage caused to children by some ministers of the Church. I am one with my brother bishops, for it is right to ask for forgiveness and make every effort to support the victims, even as we commit ourselves to ensuring that such things do not happen again.”

In the Homily of the Eucharistic Celebration FOR PEACE AND JUSTICE at O'Higgins Park in Santiago de Chile on Tuesday, January 16, 2018, he reminded us that "the Beatitudes are not the fruit of a hypercritical attitude or the “cheap words” of those who think they know it all yet are unwilling to commit themselves to anything or anyone, and thus end up preventing any chance of generating processes of change and reconstruction in our communities and in our lives. The Beatitudes are born of a merciful heart that never loses hope. A heart that experiences hope as “a new day, a casting out of inertia, a shaking off of weariness and negativity” (Pablo Neruda, El habitante y su esperanza, 5) and he added that "peacebuilding is a process that calls us together and stimulates our creativity in fostering relationships where we see our neighbor not as a stranger, unknown, but rather as a son and daughter of this land.”

During his brief visit to the Women’s Penitentiary of Santiago, the Holy Father reminded the inmates that " losing our freedom does not mean losing our dreams and hopes.... Losing our freedom is not the same thing as losing our dignity.... No one must be deprived of dignity." He also said that "public order must not be reduced to stronger security measures, but should be concerned primarily with preventive measures, such as work, education, and greater community involvement.”

On the same day, Tuesday, January 16, and at the MEETING WITH THE PRIESTS, CONSECRATED MEN AND WOMEN AND SEMINARIANS at Santigo Cathedral, he encouraged them to "renew our ‘yes’, but as a realistic ‘yes’, sustained by the gaze of Jesus.” He invited them to pray, saying “the Church that I love is the holy Church of each day.… Yours, mine, the holy Church of each day… Jesus Christ, the Gospel, the bread, the Eucharist, the humble Body of Christ of each day. With the faces of the poor, the faces of men and women who sing, who struggle, who suffer. The holy Church of each day.” And he ended his speech asking them: "What sort of Church is it that you love? Do you love this wounded Church that encounters life in the wounds of Jesus?”

At the
MEETING and GREETING OF THE POPE WITH THE BISHOPS OF CHILE in the Santiago Cathedral Sacristy, he told them that "the lack of consciousness of belonging to God’s faithful people as servants, and not masters, can lead us to one of the temptations that is most damaging to the missionary outreach that we are called to promote: clericalism, which ends up as a caricature of the vocation we have received.”

On Wednesday, January 17, in the Homily of the Eucharistic Celebration FOR THE PROGRESS OF PEOPLES at Maquehue Airport in Temuco, the Pope addressed especially the members of the Mapuche people, as well as the other indigenous peoples who live in these Austral lands: the Rapanui (Easter Island), the Aymara, the Quechua and the Atacameños, and many others... and at this airport in Maquehue, in which serious human rights violations took place. The Pope called for our construction - as artisans - of unity and the recognition of (original) cultures without violence, saying that "
the unity sought and offered by Jesus acknowledges what each people and each culture are called to contribute to this land of blessings” and that “you cannot assert yourself by destroying others, because this only leads to more violence and division. Violence begets violence, destruction increases fragmentation and separation. Violence eventually makes a most just cause into a lie.”

In the MEETING WITH THE YOUTH, in the National Shrine of Maipú, he exhorted them to be "the protagonists of change. To be protagonists. Our Lady of Mount Carmel accompanies [them] so that [they] can be protagonists for the Chile of which [their] hearts dream.” And, he reminded them that "maturing means growing and letting dreams grow and letting aspirations grow, not lowering your guard…” He also said: "How much the Church in Chile needs you to ‘shake the ground beneath our feet’ and help us draw closer to Jesus!  This is what we ask of you, that you shake the ground beneath our fixed feet, and help us to be closer to Jesus.”

In the VISIT TO THE PONTIFICAL CATHOLIC UNIVERSITY OF CHILE, the same Wednesday, January 17, he recalled the importance of the identity, of the existence and mission of the Catholic University for national coexistence and for the construction of community, telling them that the construction of coexistence “is not so much a question of content, but of teaching how to think and reason in an integrated way. What was traditionally called forma mentis.…The university, in this context, is challenged to generate within its own precincts new processes that can overcome every fragmentation of knowledge and stimulate a true universitas.” And, added the Pope, we must "seek out ever new spaces for dialogue rather than confrontation, spaces of encounter rather than division, paths of friendly disagreement that allow for respectful differences between persons joined in a sincere effort to advance as a community towards a renewed national coexistence.”
Finally, in the Homily of the Eucharist in honor of OUR LADY OF MOUNT CARMEL and in the PRAYER FOR CHILE as a Farewell, in the Lobito Campus of Iquique, on Thursday, January 18, the Holy Father encouraged us all to "like Mary at Cana… be attentive to all situations of injustice and to new forms of exploitation that risk making so many of our brothers and sisters miss the joy of the party. Let us be attentive to the lack of steady employment, which destroys lives and homes. Let us be attentive to those who profit from the irregular status of many migrants who don’t know the language or who don’t have their papers “in order”. Let us be attentive to the lack of shelter, land and employment experienced by so many families. And, like Mary, let us say: They have no wine, Lord.”

After this wealth of prophecy delivered by the Pontificate of Francis in Chilean lands, nothing remains but:  
  • Regret, if the sensationalism and the media’s curiosity focused voraciously, rampantly, vulgarly and commercially on the subject of sexual scandals and on the person of a Chilean bishop accused of protecting a pedophile priest, a matter that the Pope himself denied and in which he came out in defense of the bishop and - as noted above – for which he asked for forgiveness. Sensationalism and curiousity that - in some moments and sectors, then, could overshadow and forget the wealth and importance of the visitor and his pastoral and evangelizing mission. 
  • To hope, with the construction and the active and generous contribution of everyone, that the Gospel’s seed watered in our Chilean Homeland by Francis bears - in the near future of our beloved Nation - good and abundant fruits.

Friday, January 5, 2018

Trust between doctor and patient is key to superior healthcare.
This fall, smack in the middle of the ongoing debate about healthcare reform in the U.S., a consummate medical professional published a remarkable book that pinpoints the structural imbalance that ails the country’s $3 trillion healthcare industry. 

In “Back to Balance—the Art, Science and Business ofMedicine” (Disruption Books), Dr. Halee Fischer-Wright, president and CEO of the Medical Group Management Association, writes: “We have lost our focus on strengthening the one thing that we know has always produced healthier patients, happier doctors, and better results: namely, strong relationships between patients and physicians, informed by smart science and enabled by good business practices that create the trust necessary to ensure that patients do what they need to do to achieve” good, long-term health outcomes.

No doubt, something is seriously amiss: among industrialized nations, the U.S. spends the most per capita, but the quality of healthcare and patients’ health outcomes rank lower than those in Germany, the UK, France, and a host of other developed countries. Fischer-Wright knows her stuff: the organization she leads “represents 40,000 practice administrators and executives in 18,000 health-care organizations across all fifty states, where more than 400,000 physicians practice, providing close to 50 percent of the health care in the United States.”

The “art of medicine,” she asserts, “is being crowded out by the science of medicine—and its emphasis on evidence-based procedures, well-meaning protocols, and advances in Big-Health-Data-churning information technology.” There is a relentless “focus on time-consuming but questionable quality metrics, endless billing procedures, and an adherence to process that doesn’t necessarily put patients first.” Case in point: the author cites findings that show that “the average physician now spends nearly two hours on paperwork [digital entries included] for every hour spent with patients, if they’re lucky.”

These factors “keep creating greater distance between patients and their doctors,” writes Fischer-Wright, who insists that “we need to bring the art, science, and business back into balance — with each side playing its part and no more to drive the healthy outcomes that we all desire from health care today.”

The art of medicine, she insists, hinges on trust, the authentic bond between doctor and patient. It is the vital importance of the “human side — the big-hearted, patient-focused, high-touch, active-listening, caring, compassionate, empathetic part of medicine that has been at the heart of the doctor-patient relationship from the very beginning.” 

“A trusting relationship between physicians and patients,” writes Fischer-Wright, “based on compassion, empathy and good communication can have a profound effect on patient health. Trust aids efforts to control diabetes, lower cholesterol, and control pain. Trust improves the mental and physical quality of life of cancer patients. Trust encourages people to get regular preventive care. Trust gives older patients better outcomes and more long-lasting independence. Relationships built on trust have been shown to reduce anxiety, depression, post-traumatic stress disorder, and a patient’s use of end-of-life care. These relationships are linked not only to lower hospital readmission rates for heart failure or pneumonia, but also to more successful treatment regimens, lower health-care costs and much higher patient satisfaction scores.” Trust is everything!

Hence, the book argues, the business and science of medicine must be de-emphasized in favor of more holistic and humane treatment and involvement of the patient, making room, quite literally, for the human touch.

Fischer-Wright proposes a number of intriguing remedies to bring the art, the business and the science of medicine into proper balance. Among them, a suggestion to “design medical care for healthier people instead of strictly for diagnosis and treatment of disease.” The human person is far more complex—emotionally and spiritually—than the sum total of his or her physical condition.

Also, she recommends: “ask the people the right questions, genuinely listen to the answers and then take the right action” for doctors to find out what their patients expect from medical care, without making assumptions. 
Finally, she calls for the creation of “empowered relationships that demand balance in the art, science and business of medicine”—the doctor, the billing person, the office assistant and the patient him or herself working toward a common goal.
Restoring the fundamental trust between doctor and patient is both the foundation and objective of these vital adjustments; it holds the key to putting “the needs of people at the center of the [health-care] industry again.”

As the CEO of a unique health-care network comprised of independent New York City-based physicians, I am most heartened by Fischer-Wright’s insistence on the primacy of the doctor-patient relationship. SOMOS Healthcare (formerly Advocate Community Providers) is a so-called Performing Provider System (PPS) operating under a mandate from the New York State Department of Health as part of its Delivery System Reform Incentive Payment (DSRIP) program. The initiative’s bottom-line objective is to save taxpayers some $12 billion in unnecessary hospitalizations by the end of the program’s five-year term in 2020.

That goal is achieved, quite simply, by providing better care in terms of prevention, diagnosis, treatment, patient follow-up with CHW handholding. This way, medical conditions may be avoided and managed, avoiding emergency room visits and hospitalizations that drive the burdensome cost of the Medicaid system. 

SOMOS Healthcare was formed by community physicians to revitalize the role of the community-based primary care physician. Like the family doctor of old, these physicians often live and work in the same neighborhood as their patients. Often, they speak the same language and share the same cultural background, ensuring sensitivity to the cultural context of patients’ wellbeing. That, we are convinced, is the key to creating an intimate, trusted bond between doctor and patient.

A cadre of specially trained staff and Community Health Workers at SOMOS Healthcare help to reduce the administrative burden of our network physicians by improving workflows, streamlining billing and maintenance of Electronic Health Records, and exchanging data with the Department of Health. SOMOS staffers are also in a position to make home visits and ensure that patients are following their medical regimes. Thus, our approach echoes the author’s recommendation that shifts the balance back to the doctor-patient relationship.

As to the encroachment of the science of medicine, our primary care physicians can readily refer their patients if specialized treatment is in order—but only after a thorough discussion and examination that takes into consideration possible cultural influences or mental health issues. Ours is a sharp departure from the impersonal, transactional, and test-driven practice of Medicaid medicine.

There is one critical area, however, where we part ways with Fischer-Wright. At the core of DSRIP is a shift to a Value-Based Payment (VBP) or Pay-for-Performance formula: increasingly, compensation for doctors is pegged to the longer-term health outcomes of their patients. We respectfully disagree with Fischer-Wright’s rejection of pay-for-performance, even as efforts she has studied over the years may have missed the mark.

For SOMOS Healthcare, pay-for-performance is at the heart of enabling our doctors to be true to their calling of delivering patient-centered health care. For too long, fee-for-service has economically favored large hospital systems. A value-based formula ensures that incentives are appropriately aligned to reward physicians for personal, relationship-based, comprehensive care.

Those with the most to gain are the people — let’s not call them patients, which connotes illness — whose health and well-being are front and center. After all, shouldn’t our health care system focus on health rather than illness?

Over time, that extra effort will include the so-called social determinants of health, such as a patient’s housing and employment situation. It’s not a matter of what Fischer-Wright labels as using “money to force compliance,” but of recognizing and supporting the risk our doctors are taking as small business owners to link their professional success to the genuine well-being of their patients. That, too, is a matter of trust; rewarding virtue is a good investment.

Post-2020, when the DSRIP mandate ends, SOMOS Healthcare is poised to continue supporting our network of community physicians as a for-profit organization, one that likely will begin to address the needs of Medicare recipients as well as our base of Medicaid beneficiaries. As our operations expand and, hopefully, as other organizations in New York State and beyond follow our example, we are confident that Fischer-Wright will discover that pay-for-performance will be a crucial element in balancing the art, science and business of medicine — be it government-sponsored or commercially driven.

Friday, December 29, 2017

New Year…New Life!

For time immemorial, the arrival of a NEW YEAR has served as a catalyst for our renewed commitment to fulfill unfulfilled resolutions and to realize our unrealized hopes and dreams. This annual cycle of reflection and optimism is an engine of personal, family, and social history. 

The arrival of a NEW YEAR is like a balm, an oasis in the hustle and bustle of personal and social stories. It is an opportunity to pause and evaluate, reconsider, strategize, and redirect the path of one’s life with new fervor, insight, and motivation. 

Clearly, our view of history is not a fatalistic one predicated on a belief that human history is an inevitable succession of events that are recycled and repeated because nothing changes and everything -- as in a whirlwind, as in a whirlpool -- cyclically and spirally returns to the beginning. 

No. Our view of history -- heir to the philosophical conception of Heraclitus of Greece -- is one in which, as the philosopher himself said, "Nobody bathes twice in the same waters of the same river." In other words, we understand history as a succession of events that, linearly, reflect the unforeseeable decisions of human beings who, with their intelligence and freedom, shape and determine their personal history as well as that of their communities, organizations, institutions, and society at large. 

The fate of humanity, then, is not determined by hidden forces (the gods or the stars) that manipulate and control the course of events to an irremediable and immutable destiny – fatal and pre-determined. The story of every human being is constructed, freely and intelligently, in our daily decisions, in the anonymity and silence of our smallest tasks as well as in the grander narratives of our lives, be they noble or petty, generous or selfish, personal or civic. 

Our view of history is neither naively optimistic nor fatally pessimistic. It is true there are many reasons for confusion, sadness, and pessimism in the form of inequalities, inequities, and injustice, in the hunger and misery of so many in stark contrast to the abundance of the few. These shortcomings are evidence of a world in which human beings have not achieved solidarity, equality, trust, compassion, or even developed ways of relating to one other to envision the world as a great fraternal table in which each one of us has a seat. 

And yet, it is the hope of a better world that gives us strength, sustains us, and pushes us every day into our daily lives and being. We are men and women who live in the hope of a better tomorrow; it is this hope that marks our present. The belief in a better humanity refuses to die. 

Faced with reasons for pessimism and sadness, we need optimism to build a better world, a better society, better families, and better personal stories through our decisions both big and small, with our activities and daily tasks, starting with better values and better ways of interacting with each other. 

Inspired by a CELAM Document from the year 2000, For the Construction of the Civilization of Love, I propose that we start 2018 by saying NO to individualism, to consumerism, to the absolutizing of pleasure, to intolerance and injustice, to discrimination and marginalization, to corruption, and to all forms of violence. 

Instead, I invite you to say YES, with your words and in your deeds, with your attitudes and behaviors, to all forms of life, to love as a human vocation, to solidarity and to freedom, to truth and to dialogue, to participation and integration, to the permanent construction of peace and to respect for others, for differences, for cultures, and for the environment.

I invite you, at the beginning of this NEW YEAR, to prioritize human life over any other value or interest, to give primacy to the person over material things, to give priority to ethics over technique, to the testimony of life over discourses and doctrines, to service over power, to the worker over the job, the company or the capital, to the transcendent over all attempts to absolutize the here and now of the human being. 

I invite you to build a New Year that is NEW for the NOVELTY of our lives. There is much we have done, but much more we need to do to build hope in the midst of the despair that challenges us daily.


Saturday, December 23, 2017

Those whose lives we cannot ignore...

There are men and women whose lives mark -- for the good of all -- the history of humanity. There are men and women whose lives set a standard for every person's life. Men and women who, through their words and in their deeds, leave a legacy of good, who improve the lives of everyone on Earth; among them are Gandhi, Francis of Assisi, Paul of Tarsus, Martin Luther King, Theresa of Calcutta, Nelson Mandela, Einstein, Da Vinci, Aristotle, Marie Curie, Diana of Wales, Einstein, Muhammad, Buddha, Gutenberg, Confucius, Qin Shi Huang, Tsai Lun. JESUS OF NAZARETH is counted among them.

In December, Christians around the world celebrate the CHRISTMAS feast, the Nativity or the Birth of Jesus of Nazareth. This celebration does not correspond with an exact historical and chronological date. Christians, for whom Jesus of Nazareth is acknowledged to be the Light of the World (Jn 8:12), sought to make the birth of Jesus of Nazareth coincide with the feast of the Sun God in the Roman Empire, which today corresponds with our Christmas holidays.

About 2,017 years ago, Jesus of Nazareth was born in Palestine, which was inhabited by the People of Israel of the Old Testament and a colony of the Roman Empire in the time of Emperor Augustus. Most certainly, Jesus was born in a small village called Bethlehem (Mt 2:1ff) in a manger, about two hours away on foot from the capital, Jerusalem. His parents were named Joseph and Mary. Jesus grew up in Nazareth as a person among his people, as a son, a carpenter, a neighbor.

When he was about 30 years old, Jesus took to the roads and immersed himself with the peoples of his land (Galilee, Judea ...) to preach (Mt 4:23) the Good News that all men and women are children of God, who is the Creator and FATHER in heaven, and who is good, compassionate, and merciful. He preached that we are all BROTHERS, CHILDREN of the same Father, called to live in LOVE, as the only form of relationship between people and as the only mandate for those who, henceforth, would be called his disciples. He preached a commandment of LOVE (Jn 13:34) among human beings that emanates from the recognition of God’s LOVE for us that is concretized, especially in truth, in forgiveness and in the service of one another. He preached life in LOVE that makes us better human beings and that makes the experience of living and coexisting in society and in the world better and more livable.

He joined together with some friends, fishermen like him. People -- especially the simple, the impoverished, the marginalized, the known sinners -- followed him because they admired his "authority" (Lk 4:36), that is, the consistency in the way he lived and what he preached, between his words and his deeds, in contrast to the hypocrisy of others. Living in the love of God, whom he confidently called "Abba," or "Father" (Lk 11:2), he consoled, healed, and liberated. Those who approached him found in him "a force," that of the love of God himself, which gave them "life in abundance" (Jn 10:10).

Jesus lived his life doing good (Ac 10:38), as a man faithful to the Father and faithful to the human condition. He was a free man who, in defiance of the laws of his time, preached mercy and justice; who, facing the ostensible worship of God that neglects the human being (Lk 10:35), opted for love and the worship of God in his brother, especially in the most needy. He was a man free from ambition and greed, (Lk 12:15) free from fear (Mt 10:28) and public opinion, free from hatred and resentment, free from attachment to riches (Mt 6:24) and free from adulation (Lk 13:32) to the powerful.

Accordingly, he was killed by hanging from a cross (Jn 5:18). After his death, his first disciples, beginning with a transformative experience through which they proclaimed themselves new men and women living the same life that the Master himself had lived and preached, confessed the Risen and Living Jesus (Mt 28:6) in the midst of the Christian community and Christian life, of every Christian.

For Christians, the life of Jesus -- through love -- reveals the face of God, for "he who has seen him has seen the Father" (Jn 14:9). For 20 centuries, the Son of God has been confessed. Indeed, not a day passes in which names, events, or acts are unrelated to the life and work of Jesus of Nazareth. His impact is of such magnitude in the story of humanity that history is divided into years and centuries before and after Christ.

For all this, we Christians are preparing to celebrate, once again, the birth of Jesus of Nazareth, the one to whom we confess our "Way, Truth and Life" (Jn 14:6). This is a celebration that, despite an infinity of extraneous manifestations – decorations, lights, trees, cards, gifts -- must be lived, above all, within (Mt 6:6) every human being who recognizes God as Father, who recognizes himself as a child of God, who is capable of recognizing everyone as brothers, who seeks to live according to the plan that God has for every man and woman who comes into this world.

This is God's plan, a plan that Jesus of Nazareth designed and continues to design with his life and gospel: a new style of man and woman capable of living in the love of God given and provided to all in a life lived as a gift (Mt 10:39) and in service to others, especially those most in need of God's love in the world, so that it is always CHRISTMAS.

Wednesday, November 22, 2017

Receive, Give Thanks, Give…

Thanksgiving is a holiday that is celebrated around the world, in places as diverse as Canada, the Caribbean, and Liberia. As a national holiday in the United States, it is celebrated annually on the fourth Thursday of November.

The historical origins of this holiday involve "giving thanks" to the Divine for a bountiful harvest and the blessings of the year that is ending. The holiday’s origins also include English traditions dating back to the Protestant Reformation that emerged as a reaction to the large number of religious holidays in the Catholic calendar.

In the United States, the Thanksgiving tradition dates back to 1621, to Plymouth in today’s state of Massachusetts, where members of the Wampanoag tribe helped 102 pilgrim colonists by giving them seeds and teaching them how to fish. Over time, this celebration has become one of our most anticipated and joyous holidays.

Historical evidence suggests that, in other present-day American places like Texas, Virginia, and Florida, similar ceremonies of "thanksgiving" were celebrated, some by Spanish explorers, even before that first Thanksgiving in Plymouth in 1621.

The common thread, of course, is gratitude – the emotion that is aroused when we recognize and appreciate in everything that is, in everything we have, and in everything that surrounds us, the goodness of life. Gratitude is the recognition and appreciation of all that is given by and received from a loving and transcendent presence that we call God, or from those who are dearest and closest to us, or from so many who anonymously contribute to the greater good.

For this reason, we can say that gratitude is an essential, original, and spontaneous emotion, corresponding to the grace and benevolence of God and of life; it is gratitude that encourages and gives us strength to continue living, trusting, loving, and sharing.

Gratitude is an emotion inherent in human nature that produces in us the joy of living, waiting, and sharing "without cost, what we have received without cost" (Mt 10:7-15).

THANKSGIVING DAY is, therefore, a deeply human celebration that gives us the opportunity – together with those most beloved to us – to acknowledge how much we have to be thankful for and how much we can give on a personal, family, social, and national level.

The historical achievements of this Nation, earned through the labor and perseverance of its inhabitants, have made the United States the most prosperous country on earth. Today, we enjoy a very good quality of life compared to many other countries. This opportunity for prosperity has made the United States a safe haven, a beacon of light or land of promise to which so many men and women came and continue to arrive in search of a better life and who, with their cultural wealth and labor, enhance the present and future of this Nation.
The greatness of this Nation depends on, and will always depend on, our common purpose to care for and give thanks for the inheritance that we received from those who preceded us on this soil; while we must work to create the legacy we will leave to future generations, hoping that those who are born here and those who come here will continue to find reasons to give thanks, to love, to share, and to wait... Our greatness today compels us to care for our values, nature, institutions, and the current social infrastructure so that future generations may also experience gratitude.

Recognizing that we have so much to give thanks for, we are compelled - at the same time - to give, to share, to serve, to be supportive so that those most in need in our society and in the world have the opportunity to give thanks. Thus, gratitude becomes a permanent celebration and, above all, an everyday, common, and national attitude.


Thursday, November 2, 2017

How to fix Obamacare

HEALTHCARE advocates for the poor let out a collective sigh of relief when attempts to repeal the Affordable Care Act (ACA) went down in flames. But the story is far from told. Legislators on both sides of the aisle agree that Obamacare, as the ACA is better known, needs significant re-engineering to become economically sustainable.

Criticism, particularly on the part of conservative legislators, is focused on the cost of the plan’s expanded Medicaid provisions. The critics have a point. The established administration of Medicaid-funded healthcare is inefficient. By some estimates, waste and corruption cost U.S. taxpayers close to $140 billion a year, some 12 percent of the program’s total budget.

Lawmakers eager for a solution need look no further than a revolutionary Medicaid reform program in New York State, designed by state Medicaid Director Jason Helgerson and championed by Gov. Andrew Cuomo, who secured $7 billion for the five-year initiative. It’s called the Delivery System Reform Incentive Payment (DSRIP) program. 

This jargon-laden moniker obscures a highly innovate formula for healthcare reform. Gone is the traditional fee-for-service Medicaid model that compensates the health care provider for tests, office visits, and procedures. In sharp contrast, DSRIP shifts to a value-based payment (VBP) model in which the doctor or healthcare system is paid according to the long(er) term health outcome for individual patients.

It makes sense! Health care providers are rewarded for keeping patients healthy. This means the provider—in keeping with the medical calling, it should be added—invests time and energy in comprehensive, holistic, preventive care – ensuring patients follow medical directives, take their medicines, keep their appointments. Suddenly, the patient is at the center of the equation.

At the end of its five-year run, in 2020, DSRIP is on target to reduce unnecessary hospitalizations by 25 percent, which will represent a savings to New York State taxpayers of $12 billion. Reducing avoidable emergency room visits and hospital stays is precisely the fruit of comprehensive, holistic care. Today, it is all too common for Medicaid patients to fall through the cracks and wind up in the ER at great cost to the system not to mention the patient. Let us not forget that we are talking about real people, human beings whose illness and suffering carries its own, often-overlooked cost.

At this writing, the DSRIP program—after 30 months of laying the foundation of a complex infrastructure of clinical care models and performance measuring tools—has entered the second half of its five-year mandate. Since April 1, all 25 so-called Performing Provider Systems (PPSs) are being measured by the state according to performance targets and clinical outcomes. Encouragingly, in the first two years of the program, PPSs earned 95.78% ($2.53 billion of a possible $2.64 billion) of all funds.

It is important to note that NYS Medicaid Director Helgerson’s vision goes beyond the strictly medical and behavioral health factors that determine the well-being of a Medicaid recipient. His goal for healthcare transformation is to also address the social determinants of health. He asserts that successful, long-term reform of the Medicaid system means that, as he put it, the “healthcare sector must embrace a broader role in the communities in which we serve.” 

Research has amply shown that non-medical factors have a significant impact on a person’s health. For the bulk of vulnerable and poor Medicaid recipients living in urban settings, social or environmental conditions have a huge effect on physical and mental health: poor living conditions, pollution, crime, unemployment, lack of access to healthy foods. The list goes on.

The U.S. lags significantly on this front—even though it is very clear that neglecting social determinants of health is costing the country billions of dollars a year. In Helgerson’s vision, the primary care physician, the neighborhood doctor of old, is at the center of a coalition of service providers with expertise to address the gamut of a patient’s needs, medical and otherwise.

One notable stumbling block is the relative shortage of primary care physicians, particularly in lower-income areas. Across the board, less than 30 percent of U.S. physicians provide primary care, compared to well beyond or close to 50 percent in Canada, France, and Germany. Millions of Americans lack access to a primary care doctor, the very person who could play a central, comprehensive role in their health and well-being.

On this score, Advocate Community Providers (ACP) stands out as the only physician-led PPS in New York State. ACP’s vast network of 3,500 providers includes 1,400 Primary Care Physicians and 1,700 specialists who practice in the Bronx, Brooklyn, Manhattan, and Queens. What’s more, many live and work in the same neighborhoods as their patients—patients with whom, in many cases, they share the same ethnic background. Cultural competence is strongly emphasized by the DSRIP protocol and strongly embraced by ACP.

These neighborhood doctors know their patients intimately and understand the social and environmental factors that impact the household. They are committed to the comprehensive well-being of their patients, their families, and the communities at large. This rehabilitation of the role of the family doctor is driven and encouraged by the Value-Based Payment model, as it promotes a holistic approach to healthcare reform.

Such could be the next chapter for America’s healthcare reform, with individual states or the federal government adopting a Value-Based Payment formula to improve the quality of Medicaid care, even as it reduces waste and fraud. Making the considerable investment in a nationwide DSRIP program has the potential of truly enormous savings down the road—savings that in turn could keep Obamacare premiums for non-Medicaid insureds in check. Such radical reform should be able to garner bipartisan support.

Finally, to dream even bigger, why couldn’t the for-profit insurance companies who are part of the Affordable Care Act work with their providers and also introduce—not to say enforce—a Pay-for-Performance formula? Monies spent in the best possible way and savings achieved will benefit all parties—patients, first and foremost, but also providers, insurance companies, and the government. For the business-minded party in charge of the Administration and Congress, truly smart reform of Obamacare at all levels should be a no-brainer.

Wednesday, November 1, 2017

Comprehensive, holistic care will keep Medicaid patients healthier

It is the story of summer 2017 and a nation’s differences are laid bare as Congress struggles to formulate an acceptable law to replace the Affordable Care Act. Are the proposed replacements “mean,” or do they not go far enough? How do leaders reconcile the practical drive to slash the nation’s public health care budget with the repugnant (and politically unattractive) prospect of leaving at least 22 million fewer Americans without health insurance coverage?

How do legislators come to terms with proposed Medicaid cuts that would jeopardize health care for more than 70 million people—among them children, the elderly, people with disabilities and pregnant women—by 2026?

There is no doubt that health care expenditures in the United States need to be curbed; compared with other industrialized nations, we spend the most per capita but deliver inferior care. Medicaid as we know it has been prone to waste and fraud. However, simply cutting the health care budget will only worsen the situation for those at the lower rungs of society. These are the men, women and children our government is dutybound to provide for, and to do it well.

True reform—a goal apparently lost in the partisan bickering—would be to get smarter about exactly how health care dollars are spent, so that costs can decrease even as the quality of care improves.

A revolutionary experiment underway in a handful of states is aiming to do just that. California, Kansas, Massachusetts, New Jersey, New York, Oregon and Texas have authorized versions of the Delivery System Reform Incentive Payment program. At its heart is the value-based payment formula, which stipulates that health care providers are compensated based on their patients’ longer-term health outcomes rather than the volume of services provided (that is, transactions such as office visits and tests).

The D.S.R.I.P. model—executed in New York State by 25 performing provider systems (also known as P.P.S.’s)—incentivizes health care providers to keep a close eye on their patients’ progress, monitor adherence to medical directives, assess mental health factors and empower patients to self-manage chronic conditions. The objective is to prevent 25 percent of unnecessary hospitalizations, which, at the end of the program’s five-year mandate, is projected to save New York taxpayers $12 billion.
Imagine such a strategy implemented in all 50 states; the Affordable Care Act’s drive to cut Medicaid spending could be achieved even as the quality of care improves. This is truly the best of both worlds, satisfying both patient advocates and budget hawks.

The visionary behind D.S.R.I.P. is Jason Helgerson, the Medicaid director of New York’s Department of Health, who passionately argues that we must take into account the social determinants of health as well as a patient’s medical condition. On this score, the United States lags behind other developed nations that recognize the significance of these factors in providing health care to the poorest citizens.

Social determinants include patients’ housing situations as well as their economic, employment and educational status. In many cases, they are also affected by the criminal justice system. These nonclinical issues directly impact physical as well as mental health, and they should be taken into consideration as part comprehensive health care designed to produce lasting results.

Case in point: A recent briefing for P.P.S.’s by the New York State Department of Health on housing issues reported that indigent households often choose to pay rent over buying food; this is a practical decision but one with serious health implications, particularly for young children. Rent and housing instability is shown to put mothers at a 200 percent higher risk of depression. There is also the impact of mold, lead paint and pest infestations. As a recent study by New York University’s Furman Center showed, an increase in “poverty concentration—the extent to which poor New Yorkers are living in neighborhoods with other poor New Yorkers” compounds the impact of a troubled housing situation as a social determinant of health.

In the vision of Helgerson—who likens the D.S.R.I.P. model to a start-up driven by venture capital—the neighborhood-based primary care physician becomes a true community leader who engages local leaders and activists in the areas of housing, employment and education to form community action teams. Their mandate is to make comprehensive resources—both medical and nonmedical—readily available to the poorest Medicaid patients in order to ensure their long-term flourishing.

Comprehensive, holistic care is the solution to keeping Medicaid patients healthier, taking control of chronic illnesses and avoiding expensive emergency room visits and hospitalizations. Such comprehensive care is commensurate with respect for the human dignity of each and every human being. Our nation’s political leaders should commission research into the social determinants of health and refocus their attention on health care reform that provides states with incentives to being truly smart and innovative in how public health care funding is spent. Billions of dollars can be saved while millions of lives are lastingly improved.