Tara Montgomery, Senior Director of Health Impact, Consumer Reports

Mark Masselli: This is Conversations on Healthcare I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret some new data out on the prevalence of diabetes in this
country and as expected the numbers are on the rise.

Margaret Flinter: The rate of increase of diabetes in this country has gone from roughly
9.8% in 1994 to 14.3% in 2014.

Mark Masselli: Perhaps a more alarming is the number of Americans with pre - diabetes
38% of Americans have pre - diabetes which can often be reversed with proper diet and
exercise interventions but still very much a disease related behavior.

Margaret Flinter: Well the study did have some promising information, the rate of
increase actually has started to level off since 2008 that's too in part two greater
awareness of risk factors for diabetes. And I think we have to note since the Affordable
Care Act greater access to preventive care diagnosis and disease management.

Mark Masselli: Intervention and information are key, Margaret and our g uest today is
focusing on providing the American health consumer with materials that can inform and
educate. Tara Montgomery is the Senior Director of Health Impact at Consumer
Reports. They've develop resources for American consumers to protect themselv es
from medical harm. Find more affordable prescription drugs and become more
informed health consumers.

Margaret Flinter: And of course Lori Robertson will be seeking ways to better inform us
as well the managing editor of FactCheck.org will stop by she 's always on the hunt for
misstatements that are spoken about health policy in the public domain.

Mark Masselli: But no matter what the topic you can hear all of our shows by going to
chcradio.com and as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter we love hearing from you.

Margaret Flinter: We'll get to our interview with Tara Montgomery of consumer reports in just a moment.

Mark Masselli: But first here is ou r producer Marianne O'Hare with this week's headline news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these Healthcare Headlines. A federal judge has pave the way for a house republican led lawsuit against the Obama
Administration over the Afforda ble Care Act. The suit argue the president overreached

in his authority to increase spending on healthcare measures by billions of dollars. The
judge rule the house could move ahead with its lawsuit posing another potentially
significant challenge to the healthcare law.

And there are further threats in congress concerning health service funding with the
GOP leadership considering shutting down government over Plant Parenthood funding.
There are other health measures at risk once the budget runs out at th e end of
September, a number of programs aimed at preventing teen pregnancy and providing
family planning services are on the block. Upwards of a billion dollars in funding for the
national institutes of health also in jeopardy.

A third of American adults are obese or overweight and that obesity comes with many
risks. Earlier on set of cardiovascular disease, diabetes and premature death, now
comes another reason for concern. A recent study showed adults who are overweight
at age 50 had a higher chance o f succumbing to Alzheimer's disease at an earlier age,
this is the first study showing a link between obesity and early on set. Another reason
to get the upper hand in the battle of the Bulge.

And Monsanto has seen a setback in France the land of the disc erning gastronome a
judge in France has rule that a farmer expose to the Monsanto (inaudible 3:26 ) severed
toxic and neurological damage is a result. (inaudible 3:30 ) has been outlawed in France
and a number of other countries including Canada since 2007. This is the first lawsuit
supporting actual physical harm from exposure, Monsanto vowing to take the suite to
France's highest court. I'm Marianne O'Hare with these Healthcare Headlines.

(Music)

Mark Masselli: We're speaking today with Tara Montgomery Senior Director of Health
Impact at Consumer Reports where she currently oversees the development in
information and tools design to help the public make more informed choices about
healthcare. Ms. Montgomery served in numerous roles at consumer reports w here she
oversaw the launch of several consumer focused health initiatives. Ms. Montgomery
has served in senior editorial roles in publishing and help launch (inaudible 4:20 ) the
pioneering online learning network based at Columbia University. Ms. Montgo mery
earned her degree Kings College of London, Tara welcome to Conversations on
Healthcare.

Tara Montgomery: Thank you Mark it's my pleasure to be here.

Mark Masselli: That's great, well for most of our listeners I think they may well be aware
consumer reports is the world's largest independent product testing and consumer
advocacy organization dedicated to helping consumers make more informed choices
about the products they consume. And while consumer reports has been involved in

healthcare space for s ometime there certainly been a see - change for consumers to
have a say in both the quality of care and the cost of healthcare they consume in. I'm
wondering if you could give our listeners some background on the genesis of consumer
report health division a nd how consumer reports role is evolving in this new era of
consumer driven healthcare.

Tara Montgomery: Yes well, actually Consumer Reports was founded in 1936 and ever
since our first issue of the magazine we've covered healthcare. So we rated Alka
Sel tzer

Mark Masselli: Isn't that great?

Tara Montgomery: Claims that -- it's claims vanish like the gas bubbles in the air.

Margaret Flinter: Pop - pop, fist - first oh what a relief it is we still remember that.

Tara Montgomery: That's right and we've been active in health for decade so we
actually spoke out in favor of universal healthcare in our magazine back in 1939. And
kept working on health issues for decades but really wrapped up ten years ago when
we saw the kind of movement of health information co ming online for consumers and a
dialogue about reform. And we say health was becoming really the number one
consumer issue of that decade and we decided to step up and advocate for consumers.
One of course was to join the health reform campaign and we su pported the ACA and
make sure it had provisions that protected consumers. Along with that we worked hard
on transparency especially as technology meant that data could be more available and
we began to fight for our advocacy division to see more data abou t clinical trials results
about the safety of hospitals, about infection rates and other things. We launched the
health rating center where we began to do comparisons of health services and products
based on science. And then following healthcare reform we've been trying to help
consumers make sense of their role as, quote, consumers of healthcare to become a
more empowered health consumer which was a difficult thing to do than healthcare we
knew that if we wanted to reach people who really needed health support that we
needed to cast our net more widely and work with everyone from migrant farm worker
groups to unions.

Margaret Flinter: Well Tara certainly there's really a daunting set of choices in the
healthcare purchases being made by millions of Americans. Some 16 million new
consumers have entered the insurance market place purchasing insurance online for
the first time and many of these newly insured Americans now have to navigate the
health system in a new way. So maybe talk to us a little bit beyond the coverage aspect
how is your organization working to inform the consumer then how are you perhaps
helping the healthcare system respond to the needs of these new consumers as well?

Tara Montgomery: Well we do want a new exchanges and new plans to succeed. And
we collaborate with some of them including in California to make sure that they're very
usable as systems and that choice is really available. And we're pressing to make sure
that plans in those exchanges are really high value plans for consumers. Beyond that
we really keep an eye on the rates because cost is an issue and -- and we watch the
quality of networks because for any given health plan really the quality of their network
leads to other health decisions and other expenses for consumers. And then when
they're actually insured and covered we are interested in making sure that consumers
understand what a high value de cision looks like and then that they're using their plan
benefits wisely and they're out of pocket cost wisely. And insuring that they get the
essential care that they need.

Mark Masselli: As you've mention there's a see - change going on in the health
ins urance landscape with the rise of high deductable health plans and it was sort of
suggested it was going to empower health consumers to be more aware of their cost.
And yet on the other hand we're seeing where consumers are putting off a vital health
care due to the increase in pocket cost. I'm wondering if you could describe some of
the more challenging aspects of this trend and what's the greatest concern you have
and the fox at Consumer Reports?

Tara Montgomery: At Consumer Reports we have seen that data that consumers have
been avoiding certain healthcare due to the cost and we've done our own research that
validates that. And we also hear from consumer simply that they're mad about the
outrageous cost of their healthcare. And we're very concerned about consumer debt in
general, student debt and medical debt. I want to see that reduced. So what we're
working on to address a portion of that is fighting for price transparency which has been
a real barrier to con sumers being able to make assessments about the kind of care they
can afford. And then we're working on a campaign around surprise medical bills which
is often an issue where there is a lack of transparency or at least a lack of
communication. And we're enlisting consumers to fight that fight with us and see
(inaudible 9:47 ) changes to prevent the surprise medical bills in different states.

And then on a more practical levels the consumer we have two programs. One is called
Choosing Wisely and the other is called Best Buy Drugs which both really show people
how to spend their dollars wisely and avoid unnecessary expenses because a lot of
their time is out of pocket cost that they encounter may not have been for necessary
care they may have been for certai n kinds of screenings for examples that could have
been avoided. Thirdly encouraging consumers to shop around in the reality of this
market place and not be afraid to ask questions about cost so we really push
consumers to ask those difficult questions ab out cost.

And we also worry about the fact that the burden of cost is shifting to consumers and
that there's this expectation that consumers can take on this so called consumers
behavior very quickly. When really we're part of a long term culture shift an d there's a
lot of responsibility on the shoulders of providers and payers to support consumers in
navigating this and not leave consumers to their own devices just because they're in the
market place.

Margaret Flinter: Well Tara I'd like to go a little d eeper into one project that you mention
and that was the Choosing Wisely campaign. I understand you actually led the team a
consumer reports health that partnered with the ABIM Foundation to launch that
campaign and we always like to give a shout out to D r. Steve Smith who is one our
medical staff in our organization in Connecticut and who is one of the leading
proponents in that campaign. Maybe you could talk to us a little bit more about your
organization's role in that campaign the kind of resources yo u developed for it, we'd also
like to hear about your organization's participation in the Preventing over Diagnosis
conference at the National Institute of Health which focused on this issue.

Tara Montgomery: Well back in 2012 we built a relationship with the ABIM Foundation
and agreed that it was important to encourage conversations between healthcare
providers and patients about the evidence the safety, the cost and value information for
the test treatments and procedures that they're considering. And w e love the idea that
patients and healthcare providers can be looking at the same evidence together as they
make decisions together about what's really necessary.

So we actually partner with many specialty medical society to translate into consumer
languag e. The list items that were developed for Choosing Wisely, so Steve Smith who
you mentioned is a real pioneer in developing this idea of list of topics that should be
avoided or questioned. And we've taken list from maybe a 100 medical society and
create a consumer resources that explain why that test treatments or procedure may
not be necessary and how much these things might cost.

So we have created these resources as brochures as web pages, as videos to reach
different kinds of consumers at different s tages in their health decision making. First to
become aware of the issue of waste and other use. And then ultimately to activate
consumers to ask those difficult questions about whether something's really needed.
One of the best examples of how that's beginning to be used is the way that we
integrate consumer information into other decision tools at the point of decision making
and that include some of the transparency tools like cost like health and change health
and healthcare blue book. And then ele ctronic medical record systems which are
increasingly including Choosing Wisely resources for providers to print out, to have a
discussion with consumers.

So we are collaborating with ABIM and the societies on that. And with a huge
partnership network so that we now reach a 100 million consumers a year with content
and messages around Choosing Wisely. And antibiotics which you mentioned is now a
real focus area for Choosing Wisely and we have a grant through Robert Wood
Johnson Foundation to work with sev en regional groups to try and reduce the use of
antibiotics in upper respiratory and vile infections by 20% of the three years. And then
as for preventing of a diagnosis which is a movement that's been evolving in parallel
with Choosing Wisely. We do loo k at the over diagnosis issues and excited by the
synergy between the preventing of diagnosis movement which really leads to an over
treatment culture and it's a conversations about wasting of use. And Consumer Reports
likes to have allies working in the same direction maybe with different kinds of tactics
and different kinds of relationships but always in dialogue with one another to see how
together we can affect the market place overtime.

Mark Masselli: We're speaking today with Tara Montgomery Senior Director of Health
Impact at Consumer Reports where she oversees the development and production of
information tools design to help the public make more informed choices about
healthcare. You know, it's fascinating to hear about the sort of complexity and the
Consumer Report has and with that comes a greater degree of transparency in the
healthcare professions. We recently had Dr. Christen (inaudible 15:07 ) of the National
Quality Forum talking about the need for better outcome measurement data. Medical
mistakes this number is up in an astronomical level 100,000 deaths per year. Tell our
listeners about the work you're doing on patient safety and you've touched on some of
that already how you're providing health consumers with this reliable outcome data.

Tara Montgomery: Consumer Reports is a nonprofit advocacy organization which some
people don’t realize. And under the offices of that we have an advocacy effort called
the Safe Patient Project where a network of advocates really fight around transparenc y,
legislation, accountability and public awareness and have really led fights against
hospital acquired infections with many successes around data disclouser across the
state. And really raise the alarm around medical errors, so we have a network that
re ally fights for the data which we can then use in ratings for consumers. And we do
believe that by making that data available to consumers they can learn to make
comparisons and make choices in healthcare that will result in them being safer.

But ultimate ly yes we do believe that data helps consumers make choices and it also
helps providers understand how they can improve and that's equally important to us is
that hospitals and physicians and drug manufacturers see publicly how we're talking
about safety i ssues. So we care very much about outcomes data, we worry that there
isn't enough good data out there yet for us to do the best job we can to provide tools
and resources to consumers. So we are very encouraged by efforts to do more patient

center the out comes research because we do know that it's in a long term interest of the
healthcare system.

And we sit on many committees around quality and safety of the institute of medicine
and in fact Christ Castle [PH] organization that you mention the National Qua lity Forum
and ensure that there is improvement going on in the system separate from whether
consumers are beginning to shift our own behavior.

Margaret Flinter: Well Tara one area where consumer seem to be genuinely mystified
and that's with prescription drugs. According to a recent consumer report survey 75%
of Americans say they've had to change their spending habits to accommodate their
budgets for higher price prescription drugs and that's led to people simply not buying
their prescriptions or even a voiding visits with their providers because of it. Maybe you
could talk with us about consumer reports best buy drugs program and the resources
you've developed for consumers in that area, how does it work for them?

Tara Montgomery: It's unique and that it's unbiased and we have found that so many
(inaudible 17:54 ) drug information for consumer are funded by Pharma or there's a lot of
drug advertising in our culture that leads people to expect or ask for brand name or high
cost drugs. And so we're one of the few organizations that is able to tell the truth based
on the systematic reviews of the evidence the safety and effectiveness how there are
differences between different kinds of drugs.

Often we also conclude that people may not need to start with the drug and that's
something that again culturally maybe is not recognized very well by consumers that
there are lifestyle changes that may mean that you don’t need to start a drug. And in
every case we talk about cost and we've just created a new resource called best drugs
for less and that includes tips for consumers on ways to save on their drug which is
another tactic that is not commonly understood is how consumers can often even not
use their insurance and save money, how they can negotiate for their d rug prices. So
we are happy to keep that going in service of consumers who need to find cheaper
drugs, there's work to do to speak up against the fast increase in drug prices and
certainly the cost of new drugs which are just unfair for consumers. So the best buy
drugs program focuses more on commonly used drugs and then advocacy work we're
starting to look at more specialty drugs.

Mark Masselli: We've been speaking today with Tara Montgomery Senior Director of
Health Impact at Consumer Reports you can l earn more about their work by going to
consumer reports.org or follow her on Twitter @Tara CR Health. Tara thank you so
much for joining us on Conversations on Healthcare.

Tara Montgomery: Thank you so much.

(Music)

Mark Masselli: At Conversations on He althcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocate for voters th at aim to reduce the level of deception in US
politics, Lori what have you got for us this week?

Lori Robertson: Carly Fiorina has said that some vaccine preventable diseases are,
quote, not communicable and not contagious. And that some immunizations ar e not
necessary for children but every immunization recommend by the centers for disease
control and prevention covers a highly communicable disease. The CDCs
recommended schedule for children contains 14 vaccines and they all include coverage
against hig hly communicable diseases. Fiorina the former Hewlett - Packard CEO who is
running for the republican presidential nomination has also suggested on multiple
occasions that the vaccine for HPV shouldn’t be mandatory for school age children.
The CDC currentl y recommends that all boys and girls age 11 or 12 years old should
receive it. The HPV virus is highly communicable through many forms of sexual contact
and the vaccine has been shown to prevent its transmission protecting against strands
of the virus tha t are known to cause cervical cancer.

Fiorina has told a story about her daughter being bullied into letting her own daughter
receive the HPV vaccine. In an interview with (inaudible 21:17 ) Fiorina said there was a
difference between in measles vaccine an d a vaccination, quote, when a girl is 10 or 11
or 12 for cervical cancer just in case she's actually active at 11. But the vaccine is
recommended then because that is before most people become sexually active and
before they're at risk. According to the CDC about 14 million Americans become
infected with HPV every year. And that’s my fact check for this week I'm Lori Robertson
Managing Editor of FaceCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major pol itical players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health c are.

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. For all the people in the
world without limbs, acquiring prosthetics can be costly and out of reach. It's especially
challenging to make prosthetics for children since they are in constant state of growth.
Rochester Institute o f Technology Scientist Dr. Jon Schull stumbled upon a clever and

affordable solution provided online open sou rce templates to anyone, anywhere in the
world who has access to a 3D printer and provide prosthetic hands from next to nothing.

Dr. Jon Schull: I've made this Google map (inaudible 22:55 ) if you have a 3D printer
and you'd like to help put yourself on th is map and if you know someone who needs a
hand put yourself on this map.

Mark Masselli: So he founded that enable network which has mash thousands of
volunteer makers in upwards of 40 countries around the world providing cheap but
functional prosthetics for children in need.

Dr. Jon Schull: I think we're currently pushing 5800 identified members in our Google
plus community. And we have followings in the thousands more, we know that we've
delivered about 800 hands devices and we suspect that a comparabl e number have
been downloaded by people we can't track because we split all of our design on the
internet.

Mark Masselli: The movement has grown so rapidly the simple limb designs have
become more sophisticated as recipients of the prosthetic devices prov ide feedback for
designers to make more efficient devices.

Dr. Jon Schull: We're still working on a plausible thumbs, we're still working on
individual finger movements these things grip or un grip that's all they do. So they're
much less functional than our biological hands and they are also less functional than a
(inaudible 24:02 ) electric hand. But for kids it's huge because those expensive devices
are typically out of reach for children who would outgrow them and, you know, our
hands don’t even prete nd to look like regular hands they look like super hero, Iron Man
hand and for that there are reason. They are very popular with kids.

Mark Masselli: Enable a global collaborative network of open source designs linking to
makers with 3D printers to provide low cost prosthetic limbs to children and adults
around the world who might otherwise not be able to afford them, now that's a bright
idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I' m Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.