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HC CORR 95-B
HRC
DETERMINED TO BE AN
ADMINISTRATIVE MARKING
CONFIDENTIAL
&
INITIALS: SDB DATE: 12-5-13
PERSONAL
PHOTOCOPY
PRESERVATION
THE WHITE HOUSE
WASHINGTON
June 20, 1995
Melvin A. Benarde, Ph.D.
Director
Asbestos and Lead Center
Temple University
1616 Walnut Street (300-00)
Philadelphia, Pennsylvania 19103
Dear Dr. Benarde:
Thank you for sending me your article, "The Truth about
Health in America," in the March/April 1995 issue of Chemical
Health and Safety.
The Clinton Administration is deeply concerned about the
disparity between white and non-white infant mortality rates, and
we are working hard to close the gap. The Centers for Disease
Control and Prevention have been working with the Association of
Schools of Public Health and the Association of Teachers of
Preventive Medicine to analyze existing data on the causes of
preterm delivery. This work is nearing completion and will be
presented by the researchers in July. In addition, the Agency
for Health Care Policy and Research is supporting research on
medical practices, other interventions, and individual and
cultural behaviors that may effect birthweight in babies born to
minority and high-risk women.
The Administration is also working to coordinate Federal and
State services for pregnant women through the Healthy Start
program, which provides funds to local infant mortality reduction
initiatives. Philadelphia is home to a successful Healthy Start
project.
One of the three broad national goals of the Healthy People
2000 prevention program is to reduce the health disparities
between racial and ethnic groups. Although there is still much
progress to be made, I am pleased that a recently released update
on the success of Healthy People 2000 shows that greater numbers
of African-Americans are receiving pre-natal care and that infant
mortality among African-Americans is decreasing.
Melvin A. Benarde, Ph. D.
June 20, 1995
Page Two
Thank you again for writing. I have forwarded your article
to our health policy staff for their review.
Sincerely yours,
Hillary Hillary Rodham Rodham Clinton Clinton
T
TEMPLE UNIVERSITY
Center City Campus
1616 Walnut Street (300-00)
A Commonwealth University
Philadelphia, Pennsylvania 19103
(215) 204-6479
Fax: (215) 204-5813
Asbestos and Lead Center
March 28, 1995
Ms. Hilary Clinton
The White House
Washington, DC 20013
Dear Ms. Clinton:
The good health of the American public has been a well kept secret. Making this widely known
may help shape the type of health care system a generally healthy citzenry needs.
Best regards.
Sincerely,
M.A.Benarke
Melvin A. Benarde, Ph.D.
Director
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
MARCH/APRIL 1995
Chemical
Volume 2
Number 2
Health &
Published by the
Safety
American Chemical Society
and the
ACS Division of Chemical
Health and Safety
The truth about health in America
Shipping corrosives: What you need to know
Disposing of explosive laboratory chemicals
Seden tom
I l' IMR
lenson adm
shared
make
Pronouts
THE WHITE HOUSE
September 15, 1995
Dr. Bernardo Benes
Executive Director
Chairman's Advisory Committee
Jefferson Bank of Florida
301-14th Street
Miami Beach, Florida 33140
Dear Dr. Benes:
Thank you for sharing your experience and expertise
on health care cost containment. I have forwarded a copy of
your letter to the Office of Policy Development for their
consideration. In the interim, let me express my appre-
ciation for your support of the President and I look forward
to seeing you again in Miami next week.
With gratitude and warm regards, I remain
Sincerely yours,
Clinta
ec. Office of Policy Development
bee! Bunce Lindsey
JEFFERSON BANK
OF FLORIDA
with Trust Department
DR. BERNARDO BENES
Executive Director
301-41st STREET (ARTHUR GODFREY ROAD)
Chairman's Advisory Committee
MIAMI BEACH, FLORIDA 33140
TELEPHONE (305) 532-6451
August 30, 1995
Hillary Rodham-Clinton
The White House
Washington, D.C.
Dear Mrs. Clinton:
Today I am writing you with two ideas on health care cost containment. They are as follows:
1.) You could be instrumental in preparing legislation "Truth in Health Care" similar to "Truth in
Lending." As a Banker for the last 35 years, we are subjected to inform borrowers of the cost of
borrowing money. Is interest on loans more sensitive to the American public than health care costs? Are
the providers of health care more ethical than bankers? My answer to these two questions is no. I'd love
to see, particularly today when large corporations are buying hospitals, that every morning with their
breakfast millions of patients get a detailed bill for the prior day services. Maybe some providers will be
embarrassed to show that they are charging $15.00 for an aspirin. One of the biggest problems with the
cost of health care is that consumers are not sensitive to the cost because they feel someone else is paying
for it. This legislation will make them more aware of it. Maybe it should be accompanied by a national
advertising campaign explaining to the American people that when buying health care they should do the
same as when they are buying a car.
2.) We should do nationally what we did some twenty years ago in Dade County with our only Public
Hospital, Jackson Memorial Hospital. Jackson Memorial was a horrendous "dumping" hospital. When
I was President of the South Florida Health Planning Council, we recommended to the Dade County
Government the creation of a Public Health Trust consisting of community leaders who act as local Board
of Directors. Within 10 years Jackson became one of the most outstanding hospitals in the Nation. When
I see all the problems that Public Hospitals are having in New York City (I read the New York Times) and
probably throughout the Nation, I feel that this idea has merit. I discussed the idea with my intimate friend,
Cong. Dante Fascell. Immediately he said, "Bernardo, let's start with each Veteran Hospital in the
Country." If you would like to hear the details of the Jackson Hospital story, I'd be glad to collect the
literature. A meeting could be arranged with the key people responsible for this project so something can
be done at the national level. I know that the above two ideas will save billions of dollars and, at the same
time, improve the health care system of our Country.
A SUBSIDIARY OF JEFFERSON BANCORP, INC.
I would like the opportunity to get involved. My background is extensive in this area. In 1969 I was a Co-
Founder of the South Florida Health Planning Council and in subsequent years became its President and
Member of the State of Florida Health Planning Council. In 1979 I was President of the American
Health Planning Association. During your efforts on Health Reform Legislation I sent you an article I had
written with some ideas (exhibit one). I received a letter from Carol H. Rasco thanking me for my interest
and contribution. There are some other ideas that I have implemented in education as former Chairman
of the School Volunteer Program in Dade County which deals with voluntarism in Public School's
Management at no cost. If interested, I would be glad to share these ideas with you.
This week I have called a meeting of the most recognized leaders of Hispanics, Black, and women in Dade
County (more than 84% of the electorate) to create a group to actively support your husband's speech on
Affirmative Action. To date no one in Dade County has protested this issue supported by "The Contract
for America." It is unthinkable that while ten of thousands of Cuban Americans became successful
professionals in the last 30 years today are "Right Wing" Republicans calling your husband a "traitor" on
the Cuban issue. I'd love to discuss this further looking at 96' with your husband's political strategies.
I strongly believe that the present policy is wrong.
And Lastly, I was one of the first Miamians who contributed to your husband's campaign in 1992, in a
breakfast, when he was "Bill who?" I also attended the Inaugural Ball. I met you last year at the VIP
reception in Miami for the Summit of the Americas. The organizers sent me a picture taken with you.
Enclosed you will find an article recently published in the Miami Herald about me (exhibit two). My
Resume and Personal references are attached (exhibit three & four) along with a background of the
Democratic Party Activities in Dade County (exhibit five).
Sorry for the length of this letter but I am really upset of the injustices I suffered in 1978 from the same
people who are trying to destroy your husband because of the Cuban issue. I urge you to get me involved
(behind the scene). I am really committed. Looking forward to hearing from you.
I will be at the dinner on September 19, at The Sheraton Bal Harbour. It will be a pleasure to see you and
your husband again.
Respectably yours,
Dr. Bernardo Benes
Enclosures
BB:kmf
JEFFERSON BANK
OF FLORIDA
THE WHITE HOUSE
February 17, 1995
Cardinal Joseph Bernardin
Office of the Archbishop
Archdiocese of Chicago
Post Office Box 1979
Chicago, Illinois 60690-1979
Dear Cardinal Bernardin:
Thank you for sending a copy of your
thoughtful speech. Bill Cox also sent it
to the President.
In the past two years, I have seen
firsthand the tireless dedication of not-
for-profit hospitals to providing high
quality medical care to all patients, even
the most disadvantaged. As you noted,
these institutions have an essential
mission in caring for the growing numbers
of uninsured and underinsured in their
communities -- which is all the more
important in light of the failure to pass
health care reform last year. As you also
pointed out, we must vigilantly protect
our nation's not-for-profit institutions
as economic pressures on the health care
system increase.
Cardinal Joseph Bernardin
February 17, 1995
Page Two
Thank you for sending the speech, and
thank you again for your continuing work
and ongoing commitment to health care
reform.
Sincerely yours,
Hillary Hillary Rodham Clinton
d hope we'll have time for another
Conversation soon
February 14, 1995
William Cox
Vice President
The Catholic Health Association
Suite 204
1776 K Street, Northwest
Washington, D.C. 20006
Dear Bill:
Marilyn Yager forwarded Cardinal Joseph Bernardin's insightful speech to me. As he so
correctly points out, our nation's not-for-profit hospitals, especially our religious
institutions, have been tireless in their dedication to providing high quality health care to
even the most disadvantaged in this country. As economic pressures on the health care
system continue to increase, we must preserve the essential mission of these not-for-profit
hospitals.
Thanks for sharing the speech with me. (Cardinal Bernardin also sent a copy to Hillary.)
And thank you again for the Catholic Health Association's tremendous commitment and
contribution to the debate on health care reform.
Sincerely,
ARCHDIOCESE OF CHICAGO
Office of the Archbishop
Post Office Box 1979
Chicago, Illinois 60690-1979
February 10, 1995
The First Lady Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Mrs. Clinton:
I am pleased to provide you with a copy of a presentation I recently made to the
Harvard Business School Club of Chicago. The speech, "Making the Case for Not-For-
Profit Healthcare," details the need to preserve and strengthen the role of not-for-profit
institutions in the nation's healthcare delivery system.
I believe that the provision of healthcare services is fundamentally different from the
production and distribution of most other goods and services. The primary goal of
healthcare, like other human services, should not be economic, but the promotion of
human dignity and community well-being. Healthcare services are best advanced in
a predominantly not-for-profit delivery system with a patient-first, community
orientation.
An overwhelming majority of hospitals are not-for-profit. Only 14 percent are investor-
owned (for-profit). But the issue of not-for-profit versus investor-owned is likely to
become of increasing importance as investor-owned organizations continue to buy not-
for-profit facilities. In addition, we are experiencing an excessively commercial
healthcare environment. I question whether such developments are in the long-term
best interests of patients and communities.
Not-for-profit structures are essential to the future vitality of our nation's healthcare
system and to the values it represents. I hope you will find that my reflections
contribute to the discussion on this important subject.
Sincerely,
Joseph Card. Bernarden
Archbishop of Chicago
ARCHDIOCESE OF CHICAGO
CHICAGO
U.S. POS TAGE
Office of the Archbishop
Post Office Box 1979
Chicago, Illinois 60690
PRESENTED
FEB 10 95
≈ $688
-METER
*
*
9704200
&
*
The First Lady Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
11111 1111
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
Making the Case for
Not- For- Profic Healthcare
speech, January 12, 1995
[21pages]
MAKING THE
CASE FOR
NOT-FOR-PROFIT
HEALTHCARE
+
AS THOSE WHO SERVE
A Speech By
Cardinal Joseph Bernardin
The Harvard Business
School Club of Chicago
January 12, 1995
THE WHITE HOUSE
WASHINGTON
March 1, 1995
George L. Blackburn, M.D., Ph.D.
Deaconess Hospital
Department of Surgery
194 Pilgrim Road
Boston, Massachusetts 02215
Dear Dr. Blackburn:
Thank you for sending a copy of your preventive medicine
proposal. I very much enjoyed speaking with you, Dr. Koop and
Dr. Wynder at the White House.
Dr. Koop's Shape Up America program and the wellness pro-
grams at Deaconess Hospital are outstanding examples of private
sector initiatives to combat the health hazards associated with
obesity and sedentary lifestyles. As Dr. Koop mentioned in his
"Shape Up America" Report, medical costs related to these health
risks have reached $100 billion a year.
I would like to encourage more schools and workplaces to
follow your lead and begin programs to promote healthy life-
styles. Plans like yours -- that help people identify risk fac-
tors early on and encourage them to take steps to improve their
health -- will go a long way toward preventing illnesses and con-
taining health care costs. The documented success of the Risk
Reduction Program at Deaconess and the cost savings that you have
seen already are a testament to this fact.
Thank you again for writing. I have forwarded the
information about your wellness programs to our health policy
staff for further review.
Sincerely yours,
Hillary Rodham Clinton
cc: Lisa Haines, R.N., M.Ed.
Jen - HRC
to reziond
wants you
to this Pan
]
Deaconess
Hospital
Department of Surgery
194 Pilgrim Road
Associate Professor of Surgery
George L. Blackburn, M.D., Ph.D.
Boston, Massachusetts 02215
Harvard Medical School
Chief, Nutrition/Metabolism Laboratory
(617) 632-8543
Cancer Research Institute
Fax (617) 632-0235
December 22, 1994
Mrs. Hilary Rodham Clinton
The White House
Pennsylvania Avenue
Washington, D.C. 20500
RE:
Preventive Medicine
The Koop Foundation's
Shape Up America Campaign
Deaconess Hospital
Wellness Program
Dear Mrs. Clinton,
As promised during our private conversation together with Dr. Koop and Dr.
Ernst Wynder, President of the American Health Foundation, I am providing a
preventive medicine proposal. The program begins with:
a novel health risk appraisal focusing on self-help lifestyle benefit
stratification of risk to optimize expenditure of funds where they will
produce the best success, i.e., on high-risk individuals.
proposal for incentivizing the participant (particularly those in the work
site) to participate
We suggest use of the program by the benefits office of the DHHS Division of
Federal Occupation and Beneficiary Health Services. The National Director of the
Division of Federal Occupation and Health is located at 5515 Security Lane, Suite 917,
Rockville, MD 20852. The organization of employee health leaves the final decisions
to each region although demonstrations can be initiated out of the National Director's
office. Excellent demonstrations could take place in a variety of federal agencies that
include the IRS, the FBI and civilian populations at military bases.
" '...where science and kindliness unite "
I believe that the enclosed documents represent novel preventive health
approaches. The timing seems right to start a demonstration project. Needless to
say, it would benefit from your participation.
I hope this is one of the ideas that could be part of Health Reform Part II.
Sincerely,
Bears S Bladbun
George L. Blackburn, M.D., Ph.D.
GLB:jl
Enclosures:
Deaconess Hospital Wellness Program for Employees
Middle Class Family Incentives Toward Preventive Health via School Program
CC:
C. Everett Koop, M.D.
Ernst Wynder, M.D.
Lisa Haines, R.N., M.Ed.
Coordinator of Deaconess Team Health
Enclosure to Hilary R. Clinton
from George L. Blackburn
Middle Class America
Incentive for Preventive Health and SHAPE UP AMERICA
Among middle class Americans, major concerns currently include: 1) health
care, particularly availability and cost; 2) jobs and the standard of living supported
by their income; 3) crime; and 4) the National debt, deficit spending and taxes. An
opportunity clearly exists to link the Shape Up America campaign, and other similar
preventive health programs with the known savings in medical expenses. The
lower cost of medical care required by Shape Up participants would supply funds
increase wages and to provide other benefits such as job training as well as
creation of new and better jobs. The relationship of these type jobs and reductions
in welfare, crime, and taxes is well documented, with the benefits directly related
to the source of saving. For example, health insurance savings to the employer
could translate into increases in salary or other employee benefits. Savings to
government would be used to provide job training, forced education and other
programs to reduce dependence on welfare. Better health and better jobs can be
expected to reduce crime and government spending.
Commitment by the middle class to preventive health efforts -- particularly
Shape Up America, children's health and immunization, and other risk reduction
campaigns -- would allow the country to redirect 50 billion dollars in health savings
to other national priorities while providing real, tangible benefits to the individual.
An incremental improvement in a person's preventive Health Report Card would
1.
earn credit at a cafeteria of benefits for the employee and his/her family. Properly
communicated, this effort would be acceptable to most Americans based on recent
polling. The goal would be a modest, incremental improvement in one's preventive
health report card, which would include immunization, physical fitness, healthy
diet, healthy weight, safety belts, alcohol and smoking cessation, etc. American
Health Foundation President, Ernest Wynder, has already developed a "Health
Passport". Dr. Koop, and the Koop Institute in Public Health at Dartmouth, and the
Koop Foundation could be the collective messenger. Together with its Blue Ribbon
partners in most professional societies and volunteer health associations, they
could implement this preventive medicine program, including the Shape Up
American component across the country.
Who would lead the campaign? One possibility may be a school-based
program. Already we recruit them for smoking and alcohol cessation for
themselves and their families, and children are a key focus of Shape Up America.
I believe many government resources particularly the U.S. Preventive Task
Force and other agencies of HHS and the Executive branch, could also help make
this plan a reality. Development of strategic initiatives led by Shape Up America
and all its partners, in alliance with the executive and legislative branches of
government as well as local industry leaders could accomplish the mission.
Most important. the public, on an individual and/or family basis, would
2.
realize personal improvements in their health and income. Americans contribute to
the control of government spending and the reduction of the deficit. The linkage of
preventive health with these middle class values would provide a foundation for
understanding and expansion and would vastly improve the success of Shape Up
America. The savings that could be realized by Shape Up America obesity
component alone are substantial; adding smoking cessation and seat belt use, and
the potential 50 billion dollar savings is clearly attainable. The initial three-year
annualized saving of 50 billion dollars represents but 5% of the national health
budget. This savings would be distributed fairly among all health care trust funds
(e.g., Medicare, Medicaid, insurance companies and employers). Thus, this link
between preventive health and individual benefit could achieve two important goals
of value to most Americans: improved health and standard of living.
Indeed, we have a small demonstration of how to achieve this goal based on
a study done in employees at the Deaconess Hospital. I hope many suggestions
like this will come from the Shape Up America advisory board so that we can move
quickly from planning and communicating to implementing these plans and
obtaining results..
Enclosures:
Dupont Estimate of Lifestyle, Illness, Cost per Employee
Deaconess Health Risk Assessment
December 18, 1994
3.
Deaconess
" i
Hospital
One Deaconess Road
A Major Teaching Hospital
Boston, Massachusetts 02215
of Harvard Medical School
(617) 632-7000
December 21, 1994
Mrs. Hilary Rodham Clinton
Office of the First Lady
The White House
Pennsylvania Avenue
Washington, D.C. 20500
RE:
Deaconess Hospital
Wellness Programs
Dear Mrs. Clinton,
I am writing to follow up on your conversation with Dr. George Blackburn regarding the
Deaconess Hospital's Wellness Programs: Deaconess Team Health and Deaconess PRO Health.
This is an exciting opportunity for the Deaconess to share with you the wellness programs we
have developed for our employees and the corporate market. Your commitment to preventive
health and your support of the former, Surgeon General C. Everett Koop's health awareness
efforts and programs are to be commended.
As a result of the focus in health care shifting from treatment to prevention, and the CDC report
that 50 to 75 percent of the dollars spent on medical care are directed at treating diseases or
conditions related to people's lifestyles, Deaconess Hospital administrators began an examination
of our employee health-care delivery system. This examination identified two issues: increasing
health-care claims and insurance premiums, and the underutilization of the excellent resources
at the Deaconess.
In the Deaconess Hospital tradition of exploring the frontiers of medical practice, a team of
physicians, nurses, administrators and employees envisioned a program that would focus on risk
reduction and financial management. The plan was to target the risk reduction strategies by
developing a program aimed at improving the physical and mental well-being of individuals who
face preventable or reversible lifestyle related disorders. The goal was to move beyond the
reactive practice of treating illnesses and injuries when they occur to a more proactive approach
of identifying risk factors involved with illnesses and injuries early on and assisting people to
take the appropriate measures to maintain or improve their current state of health. As a result
of the implementation and success of the Risk Reduction Program and a review of participants'
health-care claims, we have seen a reduction in health-care costs over a four year period.
where science and kindliness unite
"
The enclosed packet contains information on both Deaconess Team Health and Deaconess PRO
Health. Through these programs, many employees at Deaconess Hospital and at several Boston
area corporations that use PRO Health have reached their goals of weight loss, participation in
exercise programs, stress reduction, and reducing the symptoms associated with chronic illness.
We at the Deaconess Hospital believe that a climate that promotes health, fitness and well-being
is essential in the work place. Should you have any questions about Deaconess Hospital's
employee wellness strategies, I would be happy to provide you with additional information. I
can be reached at 617-632-0710. Thank you again for your interest in our wellness programs.
Sincerely,
Lisa Haines
Lisa Haines, R.N., M.Ed
Coordinator, Deaconess Team Health
Deaconess
10
100 ES
Hospital
New England Deaconess Hospital
A Major Teaching Hospital
185 Pilgrim Road
of Harvard Medical School
Boston, Massachusetts 02215
(617) 732-7000
DEACONESS TEAM HEALTH
OVERVIEW
The current focus of healthcare is shifting from treatment to prevention. It is estimated
that 50 to 75% of the dollars spent on medical care are directed at treating diseases or
conditions related to people's lifestyles. In the Deaconess tradition of exploring the
frontier of medical practice, a multidisciplinary team envisioned a program aimed at
improving the physical and mental well-being of individuals who face preventable or
reversible lifestyle related disorders. The idea was to move beyond the reactive practice
of treating illnesses and injuries when they strike and to take a proactive stance by
identifying the risk factors involved with illnesses and injuries and then helping people
to take the appropriate measures to maintain or improve their current state of health.
According to the Centers for Disease Control, "lifestyle factors" have more influence on
an individual's health than all other factors combined. By making healthy lifestyle
choices people can reduce their risks of heart disease, cancer, and other serious illnesses.
The goals of Deaconess Team Health are:
To assess employee lifestyle health behaviors and risk factors for disease
development.
To effect a positive change in employees' attitudes about their lifestyle behaviors
and the impact of those practices on their health.
To reduce the healthcare costs of Deaconess employees.
To increase employee morale and productivity while reducing absenteeism.
To generate referrals to the internal medical/surgical staff.
To use program results for developing and implementing a manageable and
responsive benefit structure.
To demonstrate the effectiveness of the program with the aim of expanding to the
external market (Deaconess Pro Health).
where science and kindliness unite
"
Deaconess Team Health consists of 4 key components
ASSESSMENT
INTERVENTION
ASSISTED CARE
PREVENTION
ASSESSMENT
The assessment phase of Deaconess Team Health is centered around the Health Risk
Appraisal (HRA), a complete assessment of an employee's health status and risk factors
for disease. The employee fills out a questionnaire and takes a blood test. The
information from these is fed into the HRA machine and the Deaconess Team Health
coordinator then reviews the resulting printout with the employee to determine the
current status of their health and to make recommendations where necessary. In adhering
to Deaconess Hospital patient and employee policies, all information gained through the
HRA is held in the strictest confidence.
INTERVENTION
Deaconess Team Health has several resources available at the hospital for intervention
services, each offering different programs. Based on the personal risks identified by the
HRA, the Deaconess Team Health coordinator refers eligible employees to one of the
proven and effective programs through the research pilot program (1991 - 1993) or via
employee discounted programs.
Once an employees' health risks have been identified by the HRA, the employees
becomes eligible for one of three levels of intervention.
Level I is the most basic and most common level of service, applying to the employee
who has few or no health risks. Depending on those risks, the Deaconess Team Health
coordinator may encourage employees to participate in health awareness programs, seek
health counseling, or contact their primary physician; or the Deaconess Team Health
coordinator may refer them to a physician through the Assisted Care Program.
Level II programs provide clinical interventions for eligible employees who are identified
through the HRA as having moderate to high risk profile. These services, provided by
separate clinical areas of the Deaconess, offer medical assessment, counseling, and
limited medical intervention. The programs in the Level II category are designed to
help with high blood pressure, high lipid values, stress management and weight loss.
The longer term Level III programs are reserved for employees with higher levels of
risk, combining intervention with personalized medical treatment. Each of the three
divisions of the hospital that participate in Deaconess Team Health heave several
specialized offerings. Setting these programs apart from the Level II programs is the fact
that they are by nature more flexible, customized to the specific needs of each case so
as to offer more intensive and effective treatment.
ASSISTED CARE
This phase of the Deaconess Team Health program was established to help employees
find affordable and high-quality medical care at the Deaconess. When the Deaconess
Team Health coordinator finds during the HRA process, that an employee does not have
a primary care physician she refers the employee to one at the Deaconess where they will
get priority appointments.
PREVENTION
Deaconess Team Health coordinator provides an on-going series of monthly health
awareness programs aimed at informing the employee population about specific health
issues and helping them take preventive measures to maintain their health. The programs
are advertised in advance and then presented in highly trafficked areas of the hospital
such as the cafeteria or the lobby.
Health Awareness Programs include but are not limited to the following:
Healthy Heart
Food For Thought
Body Composition Analysis
Know Your Number - cholesterol screening
Fitness Update
Cancer Awareness
Emergency Services Week
The Great American Smoke-out
Holiday Health
Women and Healthcare Seminar Series
THE WHITE HOUSE
WASHINGTON
June 12, 1995
Ms. Ellen A. Bruce, J.D.
Director, Public Policy Division
Gerontology Institute
University of Massachusetts -- Boston
100 Morrissey Boulevard
Boston, Massachusetts 02125-3393
Dear Ms. Bruce:
Thank you for writing to share your thoughts about the Forum
on Medicare and Mammography at the White House Conference on
Aging.
For several months before we launched our campaign to
increase the use of mammography among our nation's older women, I
held "listening sessions" around the country. At these listening
sessions, I had the opportunity to hear older women, their
families, and their doctors speak out about mammography and
breast cancer. One of the things I learned was that -- as you
point out -- men can play an important role by encouraging women
to get mammograms and by supporting them if they do develop
breast cancer. In fact, one of the most touching moments of the
listening sessions took place at a senior citizens' center in
Florida, when a man in the audience stood up and talked about how
important it was to him that his wife get regular mammograms
because they had been together for a long time and he wanted her
to be around for a long time in the future.
This is why the Administration's mammography awareness
initiative is oriented towards older women and their families.
For example, in honor of Mother's Day, we kicked off the
initiative with what we called the "Mama-gram" campaign. The
campaign included pre-printed mammography reminders called "mama-
grams" that could be slipped into a Mother's Day card or bouquet
by a friend or family member -- including a husband, son, or
grandson. In addition, the President was featured in one of the
public service announcements you saw at the mammography forum to
demonstrate that men can and should talk to the women in their
lives about mammography and breast cancer. In the coming months,
the Clinton Administration will continue the awareness campaign
by working with Medicare carriers and intermediaries, state
health departments, local aging agencies, and voluntary and
professional organizations to reach out to older women, members
of their families, and health care professionals.
Ms. Ellen A. Bruce, J.D.
June 12, 1995
Page Two
Thank you again for writing. I very much appreciate your
support.
Sincerely yours,
Hillary Rodham Clinton
P.S. yeah, Wellesley!
The Commonwealth of Massachusetts
University of Massachusetts- Boston
100 Morrissey Boulevard
GERONTOLOGYINSTITUTE
Telephone: (617) 287-7300
Boston, Massachusetts 02125 - 3393
Fax: (617) 287-7080
May 10, 1995
Mrs. Hillary Clinton
White House
1600 Pennsylvania Avenue
Washington, D.C.
Dear Mrs. Clinton:
I was fortunate enough to see you at your forum on Medicare and Mammogram at the
White House Conference on Aging. I thought the forum was excellent and informative.
I would, however, like to suggest that in the campaign that there be a stronger educational
component aimed toward men. Men are very uncomfortable with the issue and women often fear
their partner's reaction as much as the illness. I think men, as well, are afraid of their own
reaction. We will reach many more women if we educate and support men in dealing with this
issue. They need to know their wive's, mother's or daughter's fears and how to support them.
Several women in my family have gone through this and I have seen how important their
husbands have been.
Obviously this is not the primary focus of the campaign. Women should be the primary
focus, but the men in their lives should be a secondary target as are doctors.
Finally, I deeply appreciate your advocacy for women, children and health. There are
many people behind you.
Very truly yours,
Ellen A. Bruce, J.D.
Director
Public Policy Division
Gerontology Institute
eb2/clinton.Itr
Wellesky-1970 -1970
GERONTOLOGY INSTITUTE
UNIVERSITY OF MASSACHUSETTS BOSTON
UMass Boston
100 MORRISSEY BLVD.
BOSTON MA 021 11B
IL'M
BOSTON
U.S.S. POSTAGE
BOSTON, MASSACHUSETTS 02125-3393
30
11 MAY
MAY 11 '95
032
995
EMETER
if
MASS
8221640 * "
Mrs. Hillary Clinton
White House
1600 Pennsylvania Avenue
Washington, D.C. 02133
PRESERVATION
PHOTOCOPY
THE WHITE HOUSE
WASHINGTON
April 20, 1995
Richard E. Burney, M.D.
President
American Medical Peer Review Association
1140 Connecticut Avenue N.W.
Suite 1050
Washington, D.C. 20036
Dear Dr. Burney:
Thank you for writing about the programs launched by several
of your member organizations to increase mammography use among
Medicare beneficiaries and for the invitation to your upcoming
health policy institute. Although my schedule will not permit me
to attend, I do want to commend you for your members' tremendous
efforts on behalf of our nation's older women.
As you may know, the Administration will be announcing a
national campaign to publicize the Medicare mammography benefit
and educate older women and their health care professionals about
its lifesaving potential. We will launch this effort with a
"Mamagram" campaign in honor of Mother's Day that will include
public service announcements, special events, informational
brochures, and other outreach efforts.
Thank you again for writing. I have forwarded your letter
to Dr. Helen Smits of the Health Care Financing Administration
(HCFA) and have asked her to call you to discuss ways for HCFA to
work with AMPRA members on the mammography campaign.
Sincerely yours,
Hillary Rodham Clinton Clinton
CC: Dr. Helen Smits
AMPRA
Jamkleen
American Medical Peer Review Association
1140 Connecticut Avenue, N.W.
Suite 1050
Washington, D.C. 20036
Phone (202) 331-5790
Fax (202) 833-2047
March 10, 1995
First Lady Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20050
Dear Mrs. Clinton,
In view of your public campaign to draw attention to women's health care issues -- particularly
mammography -- I thought it might be helpful for you to know of some other federally-sponsored
initiatives already underway to bring about improvements in this area.
A number of members of the American Medical Peer Review Association (AMPRA) -- a national
association of organizations concerned with health care quality and availability and all of whom hold
Medicare Peer Review Organization (PRO) contracts -- are currently at work to promote increased use
of mammography as a method of screening for breast cancer. As president of AMPRA, I would like to
call these programs to your attention.
In conjunction with the HCFA Medicare Health Care Quality Improvement Program, AMPRA
members working at the state and local levels have begun a variety of projects to improve the rates of
mammography among Medicare beneficiaries and to improve the quality of breast care associated with
mammography.
In Michigan, the peer review organization has learned that women in the Upper Peninsula have
much lower rates of mammography than in other parts of the state. Hospitals in the Upper Peninsula are
cooperating with Michigan Peer Review Organization to improve this situation.
The Ohio PRO, Peer Review Systems, Inc. (PRS), has developed a community-based network to
educate and inform women of the need for regular mammography screening. In partnership with the
Ohio Department of Health, the Appalachia Leadership Initiative on Cancer, county health departments,
hospitals, and mammography centers, PRS has built a broad coalition to support efforts for the early
detection of breast cancer in three rural counties in Ohio. Their approach includes both physician
education and direct beneficiary outreach through churches, pharmacies, grocery and variety stores,
banks and senior centers.
OFFICER
DIRECTORS
PUBLIC DIRECTORS
Richard E. Burney. M.D.
D. Clifford Burross, M.D.
Albert Rizzoli, M.D.
Perham L. Amsden
David M. Bee. M.D.
John W. Bussman. M.D.
Alexander Rodi, Sr., D.O.
Thomas Granatir
Charles Cain. M.D.
Raymond G. Christensen, M.D.
Thomas J. Sheehy, Jr., M.D.
Robert W. Hungate
Brenda E. Richardson, M.D.
Allen M. Fain, M.D.
David L. Thomas, M.D.
Norma M. Lang. Ph.D.
Gary D. Lower. M.D.
Ted W. Grissell, M.D.
Donald K. Wallace, M.D.
Cheryl Matheis
James S. Mcllwain. Jr.. M.D.
Theodore Will
James Mortimer
Executive Vice President
David B. Nash, M.D., M.B.A.
Jim L. Williams
Andrew Webber
Frederick D. Peterson, M.D.
The Connecticut Peer Review Organization (CPRO) has identified, through Medicare claims
analysis, three geographic areas in Connecticut with low mammography use. In response, a community
partnership including the Connecticut Department of Health, two universities, the Connecticut chapters
of the American Cancer Society and AARP and local community agencies has been developed to
increase regular screening mammography in these areas. The project includes focus groups to identify
local barriers to mammography use, beneficiary outreach in each target community and physician
education. A brochure describing CPRO's project is enclosed.
A variety of other kinds of projects related to breast care are possible through independent local
public organizations dedicated to quality improvement in health care, very similar to the "quality
improvement organizations" called for in then Senate Majority Leader Mitchell's version of the Health
Security Act of 1993. The examples given above are evidence of the utility of this model for assisting in
important federal initiatives and following through with them at the local level.
Getting a mammogram is only a first step in improving care for women with breast disease.
Other steps that should be encouraged at the local level -- and which could be carried out by quality
improvement organizations -- include:
-
analyzing trends in mammography interpretation and subsequent care through collaborative data
gathering and analysis with hospitals and other health care providers;
-
establishing guidelines for care that remain abreast of scientific advances;
-
monitoring changes in processes and outcomes of care to identify improvement and
disseminating information about successful practices in this regard;
-
educating consumers to make informed choices; and
-
promoting improvements to ensure that not only is the overall quality of care delivered of the
highest caliber, but that Medicare resources are used cost-effectively to achieve this goal.
The members of the American Medical Peer Review Association share your commitment to
improving the quality of health care for all Americans. Combining and coordinating your global
message with local and regional grass-roots initiatives could enhance the effectiveness of both our
programs and your message. With regard to message, AMPRA is hosting its annual health policy
institute, titled "Partnerships in Health Care Quality" in Washington on May 1. Perhaps you would
agree to join us and further spread the message?
If you would like more information about our work or if we can be of assistance to your efforts
in any way, Mrs. Clinton, I hope you will call on us.
Sincerely,
Richard E.Burney. M.D.
Richard E. Burney, M.D.
President
Mammography Outreach
The project involves outreach to both the beneficiary
Connecticut Peer Review Organization
and physician communities. For beneficiary outreach,
100 Roscommon Drive
the first step is to define the barriers and motivating
Middletown, Connecticut 06457
influences related to older women seeking a mammo-
gram. CPRO will work with beneficiary representa-
tives (Caucasian and African- American) from the low
use areas to obtain that information through a series of
focus group sessions. Representatives will also be
involved in the development and implementation of the
MAMMOGRAPHY
educational outreach effort for all Medicare female
beneficiaries in the target areas.
OUTREACH PROJECT
CPRO's physician outreach will focus on primary care
physicians and their office staffs. This will be accom-
plished through Physician-Hospital Organizations in
the target areas. CPRO is also working in coordination
with the Connecticut Chapter of the American Cancer
Society through its physician Primary Care Prevention
Program in two of the three areas CPRO has selected
for outreach.
CPRO, with the collaboration of its alliance partners,
believes this project has the potential to substantially
improve the mammography use rate among older
women in Connecticut.
Team Leaders:
Jeanette A. Preston, M.D.
Allyson F. Schulz
For more information about this project, contact one
of the project team leaders, Jeanette Preston, M.D. at
(203) 632-2008 ext. 242, or Allyson F. Schulz at (203)
632-6361.
Mammography Outreach
Breast cancer is the most common non-skin malig-
potential for success, minimize duplication of effort,
nancy in women in the United States. Despite strong
and use available human and financial resources
scientific evidence supporting the effectiveness of
efficiently.
screening mammography and the universal recommen-
Alliance Partners
dation that women age 50 and older undergo routine
screening, studies have shown that only about
Health Care Financing Administration
one-third of older women comply with the recommen-
CT Dept. of Public Health & Addiction Services
dations. In fact, in Connecticut, the statewide annual
American Cancer Society (CT Chapter)
mammography use rate by women 65 and older is even
University of CT Health Center
lower: 26.5% in 1993.
Yale Cancer Center
Connecticut Radiology Society
The Connecticut Peer Review Organization (CPRO)
The Travelers Insurance Co. (Part B Carrier)
performed a small area analysis based on popula-
AARP
tion-based use rates in 24 hospital service areas to
CT Commission on Aging
determine use rates for female Medicare beneficiaries
Elderly Health Screening Service
age 65 and older. The analysis was completed using
Area Agencies on Aging
Part B Medicare claims for both diagnostic and
Local Senior Centers
screening mammography codes and HCFA denominator
Susan G. Komen Breast Cancer Foundation
files data. There was definitive variation among the
(Race for the Cure)
areas ranging from a low of 10.2% to a high of nearly
31% when the annual use rates for 1993 were analyzed.
The goals of the project are:
The biennial use rate was 36.7% in 1991-1992, and
to increase mammography use in the target
37.9% in 1992-1993. This obvious need for improve-
areas;
ment in Connecticut convinced CPRO to implement an
to identify local barriers and motivational fac-
effort to increase mammography use among Medicare
tors involved in mammography use;
beneficiaries through an Outreach Project to be piloted
to develop a partnership model with beneficia-
in three low use areas.
ries and other interested groups to design and
implement outreach strategies;
Early on in project planning, CPRO recognized that
there were many other groups in the state who had an
to implement these strategies in the target
interest in achieving a similar goal. So, CPRO
areas; and
established an informal alliance to partner with them in
to identify CPRO as a resource for community
the project. This collaborative effort will maximize our
health groups for health promotion/prevention.