Dr. Coble presented a brief summary of the Caring Community Conference of Sept. 2007, which resulted in specific recommendations to improve the individual and economic health of northeast Florida. One specific recommendation was to create a Healthcare and Bioscience Council of Northeast Florida, which has now been formed and is working to address the other specific recommendations of the Caring Community Conference. Dr. Coble presented the 2008 Report of Economic Impact of the Healthcare and Bioscience Industry of Northeast Florida.

View the 2008 Report of Economic Impact of Healthcare and Bioscience Industry of NEFL

View Dr. Coble's powerpoint presentation

view video of Welcome (UNF President Delaney), Introduction (Center Director, Dr. Coble) and Dr. Morrison's presentation

University of North Florida President John Delaney welcomed the participants to the 2008 Caring Community Conference.  President Delaney thanked participants for sharing their expertise in health care, medicine, public policy and community action to improve the individual and economic health of the NEFL community as well as the global community. 

President Delaney expressed his pride in the progress and growth of the Center for Global Health and Medical Diplomacy, having developed into “the place where the community comes together” for the dialogue on health reform and health policy. 

view video of Welcome (UNF President Delaney), Introduction (Center Director, Dr. Coble) and Dr. Morrison's presentation

Jacksonville Mayor John Peyton thanked attendees for participating in the second Caring Community Conference, welcoming returnees from the 2007 Conference, as well as new participants.  He highlighted the significance of the health sciences sector for NEFL, citing superior regional assets and targeted municipal efforts to grow the health sciences industry.    Peyton noted that through community action, NEFL can leverage its assets to attract industry and achieve better health systems.   He challenged the assembly to suggest new proposals for partnering with the city to advance health sciences. 

The Mayor saluted the collaborative work of the Center and the Caring Community Conference participants. He observed that the Center has a promising future as a sustainable and important asset for Jacksonville, due to its neutral positioning (as a non-governmental entity) and its extensive support from community leaders. 

view video of Mayor Peyton's remarks

TRENDS IN HEALTHCARE REFORM

Ian Morrison, PhD
Healthcare Futurist

View Dr. Morrison's powerpoint presentation

view video of Welcome (UNF President Delaney), Introduction (Center Director, Dr. Coble) and
Dr. Morrison's presentation

Healthcare futurist and author, Ian Morrison presented his research and vision for the future of healthcare in America, focusing on the quest for value for all Americans.  He discussed historical examples of political leadership and legislation which reformed healthcare systems in America, resulting in the current system, which falls short of meeting expectations and needs for many Americans.  It is the subject of much debate this election year.

Dr. Morrison explained various models of change, and the key political and economic forces that drive healthcare reform.  He presented international data comparing healthcare spending, mortality rates, lifespan expectancy, obesity, tobacco and alcohol use, and doctor visits per capita.  He discussed the growing problem of access to care for the uninsured, and the critical need for a balance between primary care and specialty care.  Morrison explored cultural differences in values and expectations for healthcare, including Republican and Democratic values, attitudes and beliefs and how they might impact healthcare reform. 

Dr. Morrison used the “Value Equation” to explain the current status of US healthcare.  The Value Equation looks at the balance between access to care, quality of care, security of benefits and cost.  The high cost of US healthcare as a percent of GDP (16%) is 6% greater than any other industrialized country, yet many quality measures suggest that a greater “value” per healthcare dollar could be achieved.  Dr. Morrison’s research indicates that “cost” and “quality” are inversely correlated, meaning that Americans spend more and get less for their healthcare dollars.  However, Dr. Morrison concedes that there is no perfect healthcare system; all countries struggle with the value equation and make necessary compromises.   Various healthcare reform options were discussed, including “the new American compromise” which is based on a value for healthcare as both a right and an obligation. 

Dr. Morrison noted that healthcare in northeast Florida is a key employer and a regional economic asset.  He observed that the Center for Global Health and Medical Diplomacy is well positioned as a neutral convening body, to spearhead regional efforts to improve health and healthcare.      A successful regional initiative would include advances in health information technology, improvements in transparency of quality and outcome measures, and expanded coverage.

 
Dr. Morrison concluded with optimistic comments about opportunities to make a meaningful difference in regional healthcare.  Community leadership is critical to engaging stakeholders in reform that focuses on finding value and providing a continuum of care.

NATIONAL HEALTHCARE REFORM

Cecil B. Wilson, MD
Past Chair, AMA Board of Trustees

View Dr. Wilson's powerpoint presentation

view video of Dr. Wilson's presentation

NATIONAL HEALTHCARE REFORM
Dr. Wilson presented the American Medical Association’s (AMA) plan for health system reform and discussed the contributors to rising health care costs in the United States.  The AMA National Health Care Policy Agenda consists of working to improve the following: 

• Health Care Environment
• Clinical Excellence
• Health of the Public
• Physician Practice Viability and Patient Access
• Physician Education and Professionalism

The key elements of the AMA strategy can be summarized by the three “C’s:” below
CASH:  Replace the current health insurance tax exclusion now available primarily for large businesses’ employees with a system of income-related tax credits. 
CHOICE:  Enable the selection, choice and purchase of individually owned insurance whether employer provided or on the open market.
CHANGE:  Facilitate the expansion of health insurance markets to increase choice with guaranteed renewal, limits on insurance premium cost variations and reinsurance to provide protection for those with chronic conditions and catastrophic illness. 

Dr. Wilson described the rising cost of medical care as a critical discussion which must accompany health system reform proposals.  Among the factors contributing to increasing costs are:  an aging population, an increase in chronic disease much of which is caused by lifestyle behaviors, new technology, defensive medicine, prescription drugs ( the highest growing component of healthcare costs) and others.  Dr. Wilson reminded the audience that over 50% of health is determined by lifestyle behaviors, noting that in the past 20 years obesity has doubled and healthcare spending on obesity has tripled.

The AMA has four key strategies to manage rising healthcare costs:

• Reduce the burden of preventable disease
• Make the delivery of health care more efficient
• Reduce nonclinical health system costs
• Promote value-based decision making at all levels

In conclusion, Dr. Wilson applauded the work of the Center and outlined the AMA’s actions steps for change (below).

AMA’s Actions Steps for Change

GLOBAL HEALTHCARE REFORM

Otmar Kloiber, MD
Secretary General, World Medical Association

View Dr. Kloiber's powerpoint presentation

view video of Dr. Kloiber's presentation

Dr. Kloiber focused his remarks on the global situation for health system reform, reviewing prevailing models and discussing current trends in international health care policy.

He began by reminding the audience that all health care systems are deeply rooted in their cultures and values.  Because of this plurality, there is no universal fix or model to copy.   In addition, only the wealthiest nations have any system of healthcare at all.  The vast majority of the world, the developing and underdeveloped countries, including even China, essentially have no organized system of health care. 

Dr. Kloiber described the critical current human resource shortage of health professionals.  He explained the global migration of healthcare professionals from the poorest countries of the world to the wealthiest countries of the world.  The reasons for this migration include the opportunity for improved lifestyle, better reimbursement, as well as better conditions in which to serve ones patients.  The impact of this migration is that the poorest countries with the highest burden of disease now have an increasingly smaller share of the world’s healthcare workforce. 

Dr. Kloiber reviewed the founders of  the current models of health care:  Bismark of Germany, Semashko of Russia and Beveridge of Britain  The most significant difference in systems of care relates to the inherent underlying philosophy, for example, the individual right to healthcare versus the collective right to healthcare.  A country’s philosophical base will have profound implications for the health care system that country will ultimately put in place.

Dr. Kloiber concluded that traditional models of health care are eroding rapidly and that all systems are “on the move.”  When countries consider health care policy and reform it is essential to agree on the most important values, e.g., freedom, choice, social protection, profits, etc.  A national consensus based on values is the most important consideration for effective change.

Finally Dr. Kloiber reminded the audience that we must keep our problems in perspective.  In the wealthiest nations of the world most regions enjoy a ratio of one doctor for every 500 persons.  In the poorest countries, the ratio is one doctor for every 50,000 persons.

2008 Caring Community Conference, September 17, 2008

Session 2: Report from the Healthcare and Bioscience Council of Northeast Florida

view video of Panel 1

Session 2: Report from the Healthcare and Bioscience Council of Northeast Florida, was held on September 17, 2008, from 10 AM till noon, at the University of North Florida University Center. Two panel discussions addressed the ways in which healthcare reform may impact health, medical care and biomedical industry in the northeast Florida region. Members of the Healthcare and Bioscience Council of Northeast Florida and other regional experts served as panelists. Each panelist discussed a specific recommendation from the 12 Final Recommendations of the 2007 Caring Community Conference. A Question and Answer period followed the panel discussions.

Report from the Patient Care Panel
The Patient Care Panel included Mr. Hugh Greene, Dr. Robert Harmon, Dr. Helen Jackson, and Dr. Floyd Willis.

Improving Access to Care
Mr. Hugh Greene,  President and CEO, Baptist Health
Mr. Greene reported on the development of the JaxCare pilot program, a multi-payor public-private partnership funded by government, providers, businesses and employers to provide access to care for the working uninsured of Jacksonville (estimated to be 100,000 and 120,000 people).  The JaxCare program was effective, and community collaboration was extraordinary; however the program was not scalable or sustainable and it closed in June 2008. 

A new medical home model is being explored as a replacement for JaxCare, which would provide the continuity of care that exists when patients have a relationship with a primary care doctor.  Funding sources are critically needed.  Mr. Greene noted the need to celebrate the many people, organizations, and clinics that are committed to making a difference by improving or providing access to care in Jacksonville and have done so for many years.  The common thread is partnership and collaboration.

Health and Wellness
Dr. Helen Jackson, Director of Community Nutrition Services, Duval County Health Dept.
Dr. Jackson explained that improving health and wellness requires the collaborative efforts of the entire community and its resources, including business partners.   She elaborated on two specific collaborative initiatives in Jacksonville: childhood obesity and infant mortality. 

The Childhood Obesity Prevention Coalition was formed to prevent and reduce childhood obesity in Duval County.  The Coalition successfully implemented Body Mass Index (BMI) screening in Jacksonville public schools and compiled a guide of local resources for families of overweight children. 

The Jacksonville Community Council Infant Mortality Study (www.jcci.org) looked at Jacksonville’s exceedingly high, racially and socio-economically disparate Infant Mortality Rate (IMR).  The study found that the greatest direct cause of infant mortality is the birth of premature and underweight babies due to poor health of the mother.  The Study produced 15 recommendations to reduce infant mortality, including education, awareness, making healthcare services affordable, and attending to a woman’s health prior to pregnancy. 

Reducing Health Disparities and Inequities 
Dr. Floyd Willis, Chair of Family Medicine, Mayo Clinic  
Dr. Willis explained the enormous complexity of the health disparities problem in the US, noting that every major disease category disproportionately affects the less affluent or the racial minorities.  Racial and socioeconomic inequalities in health must be addressed in order to move forward building individual and economic health in the community.

Dr. Willis complimented all regional hospitals and clinics for the work being done on disparities issues.  He described a new health disparities project in Jacksonville, the Community Research Advisory Board (CRAB) which works to address the questions of healthcare disparities through the community members that suffer most from disparities, examining the complex issues of access to care, genetics, environment and behavior. 

Advancing Health Information Technology
Dr. Robert Harmon, Director, Duval County Health Dept.
Dr. Harmon advocated more rapidly adopting major changes in Health Information Technology (HIT) to improve healthcare access and quality, and contain costs. He noted that Florida is underinvested in health, especially for the uninsured, and he suggested the Council work to

• Increase delivery of preventive services 
• Increase primary care medical homes 
• Improve lifestyles
• Increase and improve HIT systems

Dr. Harmon reported on the regional state of HIT, noting that most area hospitals and large group practices have modern electronic health records.  Many partners in Jacksonville are leading the expansion of e-prescribing.   Most recently, the NEFL Health Information Consortium including the Duval County Health Department and Duval County Medical Society obtained a Health and Human Services grant for a Medicare Electronic Health Records Demonstration Project to be implemented in 2009.

Report from the Education and Research Panel
The Education and Research Panel included Judge Susan Black (by video), Mr. Marshall Criser, Dr. Robert Nuss, and Mr. Art Wotiz.

view video of Panel 2

Increasing Medical Residencies
Judge Susan Black (by video), Federal Judge of the US Court of Appeals for the Eleventh Circuit
Judge Black explained that a critical global shortage of physicians is predicted, as many physicians are among the 79 million baby boomers heading toward retirement over the next 15 years.   One way to address that shortage of physicians is by increasing medical residency programs, as statistics show that 60% of graduating doctors decide to reside and practice in the region where they complete their residency training.

Medical Education
Dr. Robert Nuss, Dean, Regional Campus, University of Florida College of Medicine,   
Associate VP for Health Affairs, University of Florida Health Science Center, Jacksonville
Dr. Nuss explained that the US medical education system is under significant stress.  To  address the coming medical manpower shortage states are increasing the number of regional medical campuses, building new medical schools, and adding residency positions to existing programs.  Dr. Nuss noted that the annual cost of training a resident is approximately $88 thousand dollars per resident, not including faculty salaries. 

Dr. Nuss elaborated on current problems in medical education including:  decreasing state and federal funds for education; lack of funding for additional residency positions; increasing competition for faculty; increasing debt for medical residents; a new policy instituting an 80 hour work rule, reducing resident training hours and work output; and a critical shortage of  medical student clerkship spots.  Dr. Nuss speculates that future residents may need to pay, rather than be paid, to perform a residency. 

Establishing a Regional Bioscience Academic Institute in Jacksonville
Mr. Marshall Criser, Past-president of the University of Florida
Mr. Criser provided an excellent historical summary and analysis of the circumstances leading up to the recruitment and startup of a subsidiary of The Scripps Research Institute (TSRI) in Palm Beach County.  Governor Jeb Bush initiated the process with Scripps and the legislature appropriated $310 million to support the operational start up costs.  Palm Beach Country was largely selected because of the opportunity for philanthropic support in that area.  Scripps will be housed in a building on the Jupiter campus of Florida Atlantic University with opening planned for the first quarter 2009. Two additional California research centers announced soon thereafter that they will be opening satellites in Florida. The Torrey Pines Institute for Molecular Science will open a facility in Port St. Lucie and the Burnham Institute for Medical Research will open a laboratory in association with the University of Central Florida in Orlando. 

Mr. Criser commented that the area’s outstanding healthcare resources, the consolidated government of Duval County coupled with the collaboration within the Northeast Florida region will benefit the long term development of the healthcare and bioscience industry.

Establishing a NEFL Bioscience Industry Campus
Mr. Art Wotiz, President & CEO NovaBone Products, LLC (NBP)
Mr. Wotiz explained that NEFL resources, including outstanding universities, hospitals, and research facilities, an educated workforce, low taxes, and an excellent quality of life, should serve as a major attraction to hi-tech businesses to form a NEFL Bioscience Industry Campus in Jacksonville (similar to the Research Triangle in NC).  The city of Jacksonville has already funded a medical tourism initiative, all of which will enhance the individual and economic health of the community.

September 17, 2008, September 18, 2008

Session 3: The Ethics of Human Experimentation

The Global Standard: The Declaration of Helsinki Revisited

Session 3: The Ethics of Human Experimentation, The Global Standard: The Declaration of Helsinki Revisitedwas held on September 18, 2008, from 6 PM till 8PM, at the University of NorthFlorida University Center.

The Declaration of Helsinki (DOH) was developed by the World Medical Association (WMA) as a set of ethical principles for the medical community regarding human experimentation. It is widely regarded as the cornerstone document of human research ethics, although it is not a legally binding instrument in international law. It draws its authority from the degree to which it has been codified in or influenced national or regional legislation and regulations.

The World Medical Association was founded in 1947.  In 1954 the first principles to guide physicians in human research and experimentation were developed.  In 1964, after numerous drafts, the Declaration of Helsinki was officially adopted.  There have been several revisions over the intervening years and in 2008 another formal revision process is underway.  Dr. Kloiber discussed some of the many ethical issues under consideration by the WMA as it strives to continually keep the Declaration current and  “fit with today’s landscape of research.”  As the Declaration of Helsinki is a consensus-based document with no legally binding status, it’s effectiveness and “authority” derives from the credence it has earned as a valuable instrument to guide physicians in the often ethically murky waters of human research.

Dr. Kloiber discussed at some length one such area where there has been and continues to be significant debate – testing of new drugs using a placebo as the control versus the current therapy.  

When a research trial compares a new drug to a placebo, the results are generally dramatically in favor of the new therapy.  Yet when compared against the current best treatment, differences of the new therapy can appear considerably less significant.   After over a decade of debate on the issue, the latest revision of the DOH will recommend that a new method should be tested against the best current method unless there are compelling scientific and safety reasons to use a placebo as the control.

Dr. Kloiber reviewed some of the current sensational news coverage regarding human research, including particularly severe side effects of new therapies and the fraudulent cloning research by a Korean scientist.

There are a myriad of reasons the Declaration requires revision.  Today these include the need to develop principles for the conduct of research with children, pregnant or nursing women, and the elderly, as well as the rights of research participants to learn of the results of the study in which they participate.

Dr. Kloiber reviewed DOH revisions currently under consideration, such as:  1)  should the DOH state general principles or provide guidance on the application of the principles; 2)  is the DOH applicable to physicians only, or to all researchers; 3)  should the DOH deal with all types of research or just “interventional” research; 4)  should the DOH use the verb “must” rather than “should” and 5)  should unidentifiable human data be included in research results?  Dr. Kloiber speculated on the answers to these questions, which would be determined by the Council and full Assembly of the World Medical Association in Seoul, Korea, October 15-18, 2008.

view the powerpoint presentation

view the program