June 1997 - Volume 5, Number 2

Featured Articles:

• First Excellence in Women's Health Awards Presented
• Leadership Seminar Examines Managed Care in California

First Excellence in Women's Health Awards Presented

"Generosity, vision, and leadership" have driven the activities of the Jacobs Institute of Women's Health over the past seven years, and these themes were celebrated in the first annual presentation of the Jacobs Institute's Excellence in Women's Health Awards. Recipients of the 1997 awardsRepresentative Nancy L. Johnson (R-CT), Delegate Eleanor Holmes Norton (D-DC), and Warren H. Pearse, MDwere honored May 15 at a gala luncheon held at the National Museum of Women in the Arts in Washington.

The event drew over 250 attendees from industry, government, academia, and the press in a lively and spirited tribute to the outstanding work of Congresswomen Johnson and Norton as co-chairs of the Congressional Caucus on Women's Issues and of Dr. Pearse as a long-time advocate of women's health, and to celebrate the achievements of the Institute.

"The idea that women's health issues extend beyond reproduction was just gaining widespread currency in 1990, when the Jacobs Institute was founded," director Martha Romans pointed out. In the years since, the Institute has become a premier source of accurate and relevant information on women's health issues at the intersection of the medical and social sciences, starting with its work on the first-ever national collection of women's health data (The Women's Health Data Book, in its second edition). She touched on several hot issues the Institute has focused ondomestic violence and adolescent girls' healthand described the progress on the Institute's managed care initiative. "Vision, leadership, and generosity gave birth to the Institute," she said, "and they are embodied in the work of Rep. Johnson, Del. Norton, and Dr. Pearse."

Rachelle Dennis-Smith, MD, vice president, health policy, of CIGNA HealthCare, lauded the work of the award winners and the Institute. "The Jacobs Institute stands apart as a source of relevant, accurate research on women's health care," she declared, in explaining CIGNA's support for the luncheon. "Dr. Pearse and his excellent journal are two of the compelling reasons we chose to sponsor this event today. Another is the commitment of the Jacobs Institute to women's health care, not only during the reproductive years but in the prepubescent years and the postreproductive years."

Sharyl Attkisson, host of "Healthweek," a weekly newsmagazine produced by The Washington Post and Maryland Public Television, presented the awards to Congresswomen Norton and Johnson. The Congressional Caucus for Women's Issues has been instrumental for twenty years in the passage of legislation focused on both social and medical aspects of women's lives, including violence against women, family and medical leave, retirement equity, civil rights, child care and support, education, access to credit, and women-owned business. Rep. Johnson has long advocated health insurance reforms to control costs and ensure universal access to affordable care; many of her proposals became part of the Kennedy-Kassebaum bill signed into law last year. Del. Norton, in her four terms, has introduced more legislation than most voting members of Congress. "If there is any signature issue in those 20 years, it is women's health," Del. Norton said, in accepting the awards on behalf of both co-chairs and all the members of the Caucus. "It is where we have gone furthest and perhaps garnered the most success."

Henry W. Foster, Jr, MD, senior advisor to the president for teen pregnancy and youth services, presented the award for lifetime achievement to Dr. Pearse, describing him as "leaving an indelible mark on women's health." Dr. Pearse, editor of Women's Health Issues and former executive director of the American College of Obstetrics and Gynecology for 18 years, has used his sense of humor, avid curiosity, and advanced knowledge to improve the health of women and to educate women's health care providers for over 45 years. The attendees, most of whom know him well, gave him a standing ovation.

The 1998 Excellence in Women's Health Awards will be awarded Thursday, May 28, 1998, in Washington, DC.

The awards luncheon was made possible through a generous gift from CIGNA HealthCare as well as the following partners, supporters, and friends:

$5,000
Anonymous
Monsanto/Searle
Ortho-McNeil Pharmaceutical

$1,500 - $4,999
Constance J. Bohon, MD
Bristol-Myers Squibb Foundation
Sarah S. Brown, MPH
Bonnie Flood Chez, RNC, MSN
Cytcyc Corporation
Dow Chemical Corporation
Eastman Kodak Company
Elsevier Science, Inc.
Fannie Mae Foundation
Foreman, Heidepriem & Mager, Inc.
C.E. Gibbs, MD and Susan Walter
Hoffmann-LaRoche, Inc.
Lilly Center for Women's Health, Eli Lilly and Company
Roderick Mackenzie
Neuromedical Systems, Inc. (NSI)
Pfizer, Inc., U.S. Pharmaeuticals, Women's Health
Procter & Gamble
Constance M. Ryan
Wyeth-Ayerst Laboratories
Friends of Warren
Ann and David Allen
William C. Andrews, MD
Virginia T. Austin
Nancy L. Buc
Robert C. Cefalo, MD
Ben H. Cheek, MD
Robert K. Creasy, MD
Crestar Bank
Crestar Securities Foundation
F. Gary Cunningham, MD
Division of Maternal/Fetal Medicine, Duke University
Ethicon, Inc. (Specialty Products Division)
Mary and John Gibbons
Dr. and Mrs. W. Benson Harer, Jr.
Dr. and Mrs. Richard S. Hollis
Joanne Howes and Marie Bass
Pat and Vince Hutchins
Dr. and Mrs. Timothy R.B. Johnson
Harry S. Jonas, MD
Richard F. Jones III, MD
Bob and Myrna Krohn
Hal C. Lawrence, MD
Irv and Kathy Meeker
Michael T. Mennuti, MD
Frank C. Miller, MD
Maurice Mullin
Murray L. Nusbaum, MD
Dr. and Mrs. Leland J. Olson
Pfizer, Inc.
Marcia and Roy Pitkin
Ganson Purcell, Jr., MD
Jan Schneider, MD
Dr. and Mrs. Richard H. Schwarz
University Ob-Gyn Foundation/Olson Center for Women's Health
H. Alexander Wanger, MD

Leadership Seminar Examines Managed Care in California

What must managed care organizations do to become more responsive to consumer concerns? And what are the particular concerns of women as managed care penetration reaches as high as 75 percent in California? These and other questions provided the focus for the first of four Leadership Seminars on women's health and managed care hosted by the Jacobs Institute of Women's Health in partnership with the Pacific Institute for Women's Health.

The overall goals of the seminar series include focusing public and health plan attention on key issues in women's health as the health care delivery system moves into a managed care environment. The first seminar, "Managed Care: Listening to Women," held April 25 at the Los Angeles City Club, drew over 100 attendees.

Bobbie Wunsch, MBA, president of Health Consulting and Management Services, provided an introduction to the program with an overview of the development of managed care. "There is indeed hope in managed care for women," she said, because it presents opportunities for delivering comprehensive women's health care, even if these opportunities are not yet being fully realized. We are currently in a time defined by intensified price competition, a situation Wunsch dubbed "the War of the Managed Care Networks," which will give way to more cooperation between health plans, purchasers, and providers, with more of a focus on quality as a result of consumer action. Managed care coverage of many services has proven better than under indemnity insurance, Wunsch pointed out, but the view of women's health held by managed care executives has been too limited focusing on issues such as abortion, mammography, and prenatal care only.

Roberta Wyn, PhD, of the UCLA Center for Health Policy Research, presented preliminary results of a new focus group study of low-income women in managed care in California. She highlighted four key areas of women's concerns with managed care: gaps in covered services, access to care (both financial and non-financial barriers), coordination of care and specialty referrals, and ways to improve care. The effects of these gaps and barriers, she pointed out, are delayed, interrupted, or foregone care. Women in the study revealed that they in fact had to become sophisticated managers of their own care under managed care arrangements, learning to navigate the plans' systems.

"Delivery systems must be responsive to the gender, cultural, socioeconomic, and age differences and needs of those they serve," said Lark Galloway-Gilliam, MPA, executive director of Community Health Councils, Inc. California has turned to managed care organizations to help solve the access problems that had developed under Medi-Cal, turning the women and children who received care through the program into what Galloway-Gilliam called "the experimental case." But she stressed that one template will not work for everyone enrolled in a system, in large part because of cultural differences. As populations are "defaulted" into managed care, it will be necessary to monitor utilization down the line, in order to assess whether access to care has been reduced.

Ellen Severoni, RN, president and cofounder of California Health Decisions, a nonprofit organization dedicated to involving the public in health choices, described CHD's approach of bringing all of the important stakeholders to the same table and engaging them in what she called "a feedback loop." The major issue under managed care that consumers, and particularly women, have identified is specialty referral. Severoni described a situation in which CHD facilitated a dialogue between consumers and a major purchaser and health plane to increase the number of "pass-throughs" or services for which referrals from a primary care provider are not required.

The needs of non-English-speaking Medi-Cal clients have been the focus of the Latino Coalition for a Healthy California. Founder and executive director Carmela Castellano described the set of standardsdubbed the Cultural Index of Accessibility to Caredeveloped by the Coalition after it identified Latino and Latina language-based access problems with HMOs in 1992. The standards were adopted as part of the Medi-Cal two-plan model. "We hope to expand the use of the Index beyond Medi-Cal plans to all health plans serving diverse populations," Castellano said. Like the work of California Health Decisions with individual plans and purchasers, the Coalition's success demonstrates that consumers can indeed influence the process of health care delivery within managed care.

The next seminar in the Women's Health and Managed Care Leadership Seminar series will be held June 25 in Oakland, California (see On the Agenda in this issue). Funding for the seminars is provided by the James Irvine Foundation.