Category Archives: Notes from the Trail

The 21st Century Cures Act was recently signed by President Obama and will allocate over $6 billion to health-care initiatives in the next ten years.

By Daniel Witke

The 21st Century Cures Act was recently signed by President Obama and will allocate over $6 billion to health-care initiatives in the next ten years.

$4.8 billion will be distributed to three signature research programs: Vice President Joe Biden’s Cancer Moonshot, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative and the Precision Medicine Initiative. The proposed legislation would also give states one billion to fight the opioid crisis and deliver an additional $500 million to the FDA. The bill received overwhelming bipartisan support after a 392-26 vote in the House and a 94-5 vote in the Senate.

As we begin 2017, it is important to understand how these provisions will play a role in the ever-changing landscape of health-care.

Winners: Pharmaceutical and Medical Device Companies, Medical Centers and Mental Health Facilities

The $4.8 billion allocated over the next ten years will help the Cancer Moonshot, BRAIN and PMI by providing the funding needed for research. Universities and medical centers will use the funds for research grants towards cancer, neuroscience and genetic medicine. The bill attracted lobbying activity from 60 schools, 36 hospitals and several dozen groups representing physician organizations.

With opioid-related deaths continuing to rise in this country, the one billion in state grants over the next two years will be allocated to facilities and research.

Representative Tim Murphy (R-Pa.), who is also a psychologist, was a driving force behind the bill because of the provisions that will fund mental health-care programs.

“To all the families who brought their stories out of the shadows, that dared to share their sorrows, their hopes, their shattered dreams, today is a day of joy,” said Murphy.

The Cures Act has provisions that will allow drug and device companies to push their products through the FDA faster. The massive lobbying effort from 58 pharmaceutical companies, 24 device companies and 26 biotech companies supported this provision.  According to the Advanced Medical Technology Association, which represents 300 medical device companies, the Cures Act will allow a quicker path for breakthrough medical technologies to help patients with life threatening conditions.

“Passage of this important legislation is a milestone in improving the innovation ecosystem for medical technology and ensuring the availability of new lifesaving, life-enhancing devices and diagnostics for patients,” said Advanced Medical Technology’s CEO, Scott Whitaker.

However, the bill has been the subject of debate. It includes provisions that will greatly impact the FDA, Consumer and Patient Safety Groups, and Public Health.

Losers: The FDA, Consumer and Patient Safety Groups, and Public Health

One notable opponent of the bill was Senator Elizabeth Warren (D-Mass). One of Warren’s biggest criticisms is the faster approval of prescription drugs and medical devices.

“Pushing treatments without scientific evidence that they work is fraud – fraud that can hurt people,” said Warren.

The FDA is currently the fastest regulatory system in the world and can be potentially life-threatening if the approval process is pushed even faster. Rita Redberg, editor of the journal for JAMA Internal Medicine wrote this bill could amount to a dangerous trade-off: “In our rush to find new effective treatments, we should not harm our patients with ineffective toxic ones.”

The legislation also affects consumer and patient safety groups.

Dr. Michael Carome, Director of Public Citizen’s Health Research Group, said he was especially concerned about the provisions relating to the drug approval process.

“The summary data could hide important information about the safety and effectiveness from the FDA scientist reviewing the data,” Carome said. “I’m disappointed to see it. ’’

Finally, the bill will cut $3.5 billion over the next ten years from the Prevention and Public Health Fund, which was established under the Affordable Care Act. The fund sets aside money for prevention programs to help battle Alzheimer’s disease, hospital acquired infections and chronic illnesses.

With this legislation affecting so many different areas of health-care, it is more vital than ever to monitor these provisions. No matter the time, day or year, TogoRun is beyond ready to tackle the challenges ahead.



Millions of Steps & Counting!

PR Team at TogoRun to get more TogoFit™ during Employee Wellbeing Month in June

For the past year, TogoRun, a leading healthcare communications agency, has been creating a healthy workplace—one employee at a time—via TogoFit, its signature, employee wellness initiative tamiflu price. To mark the 8th Annual Employee Wellbeing Month (EWM) in June, TogoRun, a proud EWM supporter, is encouraging team members to participate in a number of wellness activities throughout the month, culminating in the 2nd Annual TogoFit Games.

TogoFit is a voluntary, socially-integrated initiative that challenges employees to get or stay fit by maximizing their daily steps and active minutes, and tracking their progress via FitBit. Each workday begins with an e-letter focused on positive lifestyle habits, including healthy recipes and exercises, in addition to daily tracking of employees’ steps, distance and active minutes. In recognition of EWM, TogoFit will challenge employees to increase their focus on personal health and fitness through participation in TogoRunning Club Tuesdays, Workout Video Wednesdays and healthy potlucks. At the finish line of EWM will be the TogoFit Games, from June 20-24, a week of short physical activity challenges that will test strength and fitness across TogoRun offices.

To mark the start of EWM, TogoRun is sharing the “TogoFit Five”—five health and wellness tips from five TogoRun employees who consistently rank in the TogoFit top tier:

  1. “Walk when possible. Take a stroll around the office or around the block, and think twice before driving somewhere that is within walking distance.”
    • Amy Thomas, Account Supervisor
  2. “Don’t fear the plank. Planks are a static exercise—meaning the body stays in one position—require no equipment, and can be performed just about anywhere. They’re an excellent, low-impact way to strengthen your core.”
    • Sofia Perry, Administrative Assistant
  3. “Enjoy your exercise. Make sure you like the activity you choose so it doesn’t become a chore.”
    • Jessica Greenman, Senior Account Executive
  4. “Wake up and workout. Check it off your list and enjoy the positive benefits all day long.”
    • Kelly Sousa, Account Supervisor
  5. “Walk with purpose everywhere you go and wear your FitBit to mark your progress. But don’t forget to treat yourself. You deserve it!”
    • Gloria M. Janata, JD, President and Senior Partner

“Health and wellness doesn’t just define our award-winning communications work at TogoRun—it also embodies who we are and how we strive to live each day,” said Gloria M. Janata, JD, president and senior partner. “In reality, every month is Employee Wellbeing Month at TogoRun, but EWM give us an excuse to step it up!”

Learn more about health and wellbeing at TogoRun at, and Employee Wellbeing Month at


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HC Policy Power Players Series: National Quality Forum

By: Annie Martello

National Quality Forum

At TogoRun, we pride ourselves in finding and telling the untold stories—stories about important people and organizations who have not received the recognition they deserve.

When it comes to healthcare policy in the U.S., the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and the White House are household names; however, there are many other groups frequently overlooked despite their influence in building the future of healthcare.

In this edition of HCPolicy Power Players, we focus on profiling the non-profit/non-partisan National Quality Forum (NQF).


The National Quality Forum is a non-profit and non-partisan membership organization whose mission is to drive improvements in healthcare. The NQF was established in 1999 based on recommendations made by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. These recommendations concluded that an organization was needed to promote and ensure patient protections and healthcare quality through measurement and public reporting. Its current President and CEO is Christine K. Cassel, who previously held the same title at the American Board of Internal Medicine (ABIM) and the ABIM Foundation.

The NQF is comprised of more than 400 member organizations that represent a vast range of healthcare interests. From consumers and physicians, to government and public health agencies, to pharmaceutical and medical device companies, the NQF spans the spectrum of healthcare.

What It Does

The NQF works to achieve its mission by setting and shaping national quality improvement priorities, endorsing and setting national standards, advancing electronic measurement, and promoting outreach and education programs.

Shaping Priorities

Through NQF-convened partnerships, like the National Priorities Partnership (NPP), the NQF helps to set and shape national healthcare improvement priorities and then determines the best course of action to meet them. The NPP is a cooperative of 52 major national organizations with a shared vision to create a healthier population through a safe, effective, equitable and value-driven healthcare system. Through the NPP, the NQF was able to establish a national blueprint for achieving this high-value healthcare system—The National Quality Strategy. The NQS sets clear goals to help the nation focus its efforts and have a coordinated plan of attack.

Setting Standards

The National Quality Forum uses a rigorous and formal process to evaluate and endorse several different kinds of standards—performance measures, best practices, frameworks and reporting guidelines. NQF’s “Consensus Development Process” involves eight steps:

  1. Call for nominations
  2. Call for candidate standards
  3. Candidate consensus standard review
  4. Public and member comment
  5. Member voting
  6. Consensus Standards Approval Committee (CSAC) decision
  7. Board ratification
  8. Appeals

Advancing Electronic Measurement

The National Quality Forum has developed health IT initiatives to support the prevailing move toward electronic measurement. In 2011, the NQF converted 113 of its endorsed quality measures into an electronic format—eMeasures. eMeasures provide greater consistency and standardization in measuring performance results. In 2011, the NQF also released the Measure Authoring Tool, which allows for the development of standardized eMeasures for use across electronic health records (EHRs) and clinical IT systems.

Additionally, the NQF has developed the Quality Data Model (QDM). The QDM is an information model that acts as a guide for the effective automation and standardization of electronic health record use. The QDM makes data entered into EHR systems more easily measurable and identifiable.

Outreach and Education

The NQF provides reportstools, events and information for use by physicians, healthcare communicators, consumers and others in the healthcare industry. Some of its main outreach and educational materials include: a directory of reports, endorsement summaries, endorsed measures, graphics, a Health IT knowledgebase and an action registry.

The Impact

Why Quality Standards Matter

In 1999, the Institute of Medicine estimated in its famous “To Err Is Human” report, that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. More recent studies report that these numbers are actually much higher than previously believed. According to a 2013 estimate published in the Journal of Patient Safety, more than 400,000 Americans die annually in part because of avoidable medical errors.

These errors also have a serious fiscal impact. One of the most recent studies to measure these expenses found that medical errors cost the country around $19.5 billion annually, most of which is spent on extra care and medication.


Due to its stringent and involved consensus process, NQF-endorsed measures are considered the “gold standard” for healthcare measurement in the U.S. The federal government and many other private sector organizations use NQF-endorsed measures above all others and nearly all are in use.

Apart from its endorsed standards, one of the initiatives the NQF is best known for is the creation of its report on Serious Reportable Events (SRE) in 2009. Serious Reportable Events are “preventable, serious, and unambiguous adverse events that should never occur.” These events usually end in death or serious harm to a patient due to medical error and are often referred to as “never events,” as they should never happen. The NQF has compiled a list of 28 SREs in six categories— surgical, product or device, patient protection, care management, environment and criminal. By identifying these SREs, the healthcare industry can work to eliminate them.

Today, the NQF continues to push for the reduction and proper handling of medical error. One of its recent initiatives includes advocating for legislation that would require hospitals to adopt written policies that address the management of adverse events.

The Bottom Line

The NQF persists as one of the strongest voices in championing the enforcement of quality in all areas of healthcare. It can be counted on to advocate on behalf of all major legislation and initiatives that focus on improving the healthcare system. Its strong advocacy for policies to promote safe and high-quality healthcare coupled with its leading-edge efforts makes the NQF an organization to know and follow.

Let’s Talk About Cuba

By: Emma Berry


The word of the day is “Cuba.” With the restoration of Cuban-American relations, Cuba is re-entering the U.S. media stream in no small way. In the past month, America has been excited about the re-establishment of the embassies, enraptured by the U.S.-Cuba showing in the Gold Cup quarterfinals and abuzz with discussion of President Obama’s foreign goals for our neighbors to the South. We talk about what America can do for Cuba, but what are we not talking about? After over half a century of silence, what is still unheard?

Healthcare is a universal necessity that affects quality of life, both mentally and physically. The conversation it sparks bridges cultural gaps and unites even conflicting nations under a common goal.

World Health Organization (WHO) director-general Dr. Margaret Chan called the elimination of the transmission of a virus one of the “greatest public health achievements possible.” Now, Cuba has done just that. The island nation has a history of successful disease interventions: Medicines for diabetic foot ulcers, lung cancer and hepatitis B. It developed a meningococcal vaccine more than 20 years before America did. And, in early July, the WHO announced that Cuba had effectively eliminated mother-to-child HIV transmission, a massive stepping stone towards an HIV-free generation. With 1.2 million Americans infected with the virus and an estimated 12 percent unaware that they are ill, this is a topic the U.S. should be talking about. But we’re not.

As Ebola ravaged nations in West Africa last year, international providers traveled to the region to lend a healing hand. America sent 65 health workers to Liberia. Cuba sent 165. Cuba, whose cultural approach to medicine teaches a sense of responsibility to help people in need, simply asks students of Havana’s Latin American Medical School (ELAM) to work in underserved world communities in exchange for their education.

Cassandra Curbelo, an American ELAM student, said that the school teaches students to “better understand what patients’ lives are like.” As America strives to achieve equal access to healthcare and transition to patient-centered care, this is a topic the U.S. should be talking about. But we’re not.

So why isn’t it a topic of discussion?

Healthcare isn’t sexy. The top social media influencers in the healthcare space are not celebrities or glamorous public figures. They are educational institutions, renowned doctors and top tier news outlets. When social media users discuss Cuba on Twitter, they aren’t talking about HIV or Ebola- they are talking about soccer, travel and Obama.



Healthcare doesn’t have the “wow” factor that many other high-profile topics have in today’s media landscape. What it does have, however, is need. The world needs healthcare; it needs access, treatment and resources. Healthcare deserves to be talked about so that it can continue to be improved.

America has a population of over 300 million people, a GDP per capita of over $50,000 and spends 17.6 percent of its total GDP on healthcare – more than any other nation. Cuba is home to just 11 million people, only slightly larger than New York City. It has a GDP per capita of about $10,000. For every $20 that the U.S. spends per capita on health, Cuba only spends about $1.

But we have comparable age structures and life expectancies. Birth rates in both countries are significantly lower than the world average. Infant mortality rates are even closer – Cuba has the 33rd lowest rate and the U.S. has the 34th.

To put that into perspective, New Jersey, one of America’s wealthiest and healthiest states, has a comparable population size to Cuba and spends over $1,000 more per capita on healthcare than the U.S. national average. Yet, the health outcomes are surprisingly similar. New Jersey’s life expectancy is only three years longer than Cuba’s and its infant mortality rate, in the lowest 15% of America, is still higher than the Caribbean country’s.

When it comes to public health, Cuba and the United States have a great deal in common despite our socioeconomic differences.

The question now becomes: What can we stand to learn from Cuba and what, in turn, can Cuba learn from us?

America’s public perception of Cuban relations is historically negative, but this new relationship provides both countries with an opportunity to collaborate for the first time since 1961. Collaboration, however, requires an open flow of both communication and information.

Regardless of personal or political beliefs, Cuba’s healthcare system is something we should be talking about because improving the quality, safety and effectiveness of the global healthcare structure is beneficial to all. Maybe we can learn from Cuba’s low-cost public health system and maybe they can learn something from our emerging health tech revolution.

As President Obama strives to foster a sense of friendship with Cuba, it is important to remember that this means an open dialogue between both nations. America needs to continue to discuss Cuba in order to understand what that friendship will mean for our country, exchange ideas on what healthcare can and should be and recognize opportunities to learn. After over half a century of silence, we can’t afford to sacrifice more.

On International Women’s Day, TogoRun Celebrates Record Number of Female Mushers in the 2014 Iditarod®

The tenacious spirit of professional female athletes continues to inspire women across the globe and help break barriers to allow more and more women to compete in arenas, stadiums and on race tracks in events that have been historically dominated by men. In 1949, Sara Christian was the first female driver to race in NASCAR. Today, Danica Patrick has brought national attention to the sport and women’s contributions to its popularity. In 1993, Julie Krone was the first female jockey to win a triple crown race and later became the first woman inducted into national Museum of Racing and Hall of Fame. And just weeks ago at the 2014 Sochi Olympic Games, women broke into another established “boys club” sport when the games held its first-ever female ski jumping event.

As countries around the world observe International Women’s Day on March 8, 18 trailblazing female mushers will show their determination and grit as they compete in the 2014 Iditarod® dog sled race, which spans more than 1,000 miles of the Alaskan wilderness. These fearless women make up the largest group of female participants to have ever taken on this rigorous journey. The trek can last anywhere from nine to 15 days, with mushers facing extreme temperatures and unpredictable forces of nature along the way. A they set out from Anchorage to Nome, Alaska, these women will be proudly continuing the rich history of women breaking into sports that once largely excluded them.

International Women’s Day began in the early 1900s to celebrate inspirational women, the feats they’ve accomplished and their contributions to society. To commemorate this important day, the global communications firm TogoRun is honoring the courage, stamina and tenacity of these 18 mushers, including sponsoring 30-year-old Monica Zappa, a geographer and meteorologist from Kasilof, AK. Monica raised her team of dogs and trained for three years before hitting the trail for the first time this year.

Regarded as the “last great race on earth,” the Iditarod® commemorates Alaska’s rich dog sled history, particularly the emergency dog sled relay in 1925 to provide diphtheria serum to the desperately ill residents of Nome. The original mushers in that life-saving relay traveled  what now makes up a portion of the Iditarod® trail. The race as it is run today began in 1973  to honor and help preserve this history.  Although the initial field of racers was heavily dominated by men, it only took one year before Mary Shields made history by becoming the first woman to complete the race. To date only two women have won the Iditarod® —Libby Riddles in 1985 followed by the late Susan Butcher, who won an incredible four times (1986, 1987, 1988 and 1990).

TogoRun is named for the Siberian Husky sled dog Togo, who ran the longest leg of the diphtheria relay to Nome under the harshest conditions. Togo was one of the smallest dogs to lead a team, but he made up for it with fierce focus and fighting heart. While Togo is well-known in Alaska, many other Americans are more familiar with Balto, the dog that led the final team in the relay into Nome. “Togo didn’t get quite as much credit as he should have,” said Iditarod® veteran DeeDee Jonrowe, who is competing in this year’s race. “I think of a brave little dog.” As for Zappa, she’s excited to carry on the spirit of this unsung hero. “The Iditarod® is the ultimate test…I’m very honored to carry the Togo name,” she said.

Gloria Janata, President and Senior Partner of TogoRun, is elated to shine a light on Monica’s story as well as the participation of all the women making history this year by hitting the trail. “We’re thrilled to recognize these outstanding women mushers. The strength, determination and drive they all show truly embody the spirit of our namesake, the Siberian Husky sled dog Togo.”

International Women’s Day began at a time when women had few opportunities.  But over the years as women have ascended the ranks of prime ministers, astronauts, surgeons and positions in other male-dominated fields such as sports, International Women’s Day has become a celebration of what women have and continue to accomplish – including those who are taking on the adventure of a lifetime by participating in the Iditarod®.

Today, the Iditarod® represents one of the most physically grueling and strenuous tests of women’s determination and grit. Join us in saluting this year’s field of female mushers and cheering them on to the finish line!

As the tradition continues and grows, so too does the number of female mushers hitting the trail. This YEAR’S roster includes 14 Americans as well as women from Canada and Norway, including: Anna Berington, Kristy Berington, Paige Drobny, Cindy Gallea, Ellen Halverson, Karin Hendrickson, DeeDee Jonrowe, Katherine Keith (Rookie), Lisbet Norris (Rookie), Jessie Royer, Jan Steves, Abbie West (Rookie), Monica Zappa (Rookie), Aily Zirkle, Marcelle Fressineau (Canada, Rookie), Michelle Philips (Canada), Karen Ramstead (Canada) and Yvonne Dabbak (Norway, Rookie).

To learn more about the race and its participants, including Monica Zappa, contact Andrew White at TogoRun in Washington, D.C. at 202-909-5864 or Also, please visit® to learn about the history of women in the Iditarod®.

Telling Togo’s Tale: A Photo Essay

Photos by Marc Heft. Video by Theresa Rotunno





The Iditarod was inspired by the 1925 Race for Mercy or Serum Run, during which life-saving diphtheria serum was delivered to Nome via sled dog teams. All of the dogs were amazing, including the most famous, Balto. But it was Leonhard Seppala and a 12-year old, undersized husky, named Togo, who led a team five times further than any other sled dog team over treacherous, unchartered territory. Without Togo, the villagers of Nome would likely have perished. This blog post is part of TogoRun’s campaign to tell Togo’s untold story.

Telling Togo’s Tale: The end is the just the beginning
Extinguished widow’s lamp in Nome. By Marc Heft.
Extinguished widow’s lamp in Nome. By Marc Heft.

The 41st Iditarod has drawn to a close.

The residents of Nome return to their daily routines, the snow and wind erase the tracks of the 66 sled dog teams who traveled over 1,000 miles.

But perhaps the most telling sign the Iditarod has ended is the extinguished “widow’s lamp.”

The widow’s lamp—hung atop the finishing line—burns red throughout the race symbolically helping mushers reach Nome, but it is not extinguished until the last musher “returns” safely.

The untold story behind this lamp dates back to the 1800’s/early 1900’s Alaskan history. Alaskan mail and freight mushers would light the lamp outside checkpoints to help guide those who were out in the wilderness and it would not be extinguished until the musher successfully returned to the checkpoint—hence the reason the lamp burns during the whole of the Iditarod. Continue reading

Telling Togo’s Tale: Age is just a number– Mitch Seavey is proof
Mitch Seavey
Mitch Seavey. Photo by Marc Heft

During the historic 1925 Race for Mercy (Serum Run), Togo, the legendary Siberian husky, led Leonhard Seppala’s team across dangerous Alaskan terrain. At the time, Togo was 12 years old, an age when most sled dogs would retire; but, with his boundless energy, courage and determination, Togo pulled through the harsh weather conditions and ran more miles than any other team in a race against the clock. To Togo, age was just a number.

Similarly, this notion is shared by 53-year old Mitch Seavey, winner of the 41st Iditarod, who also emerged as the oldest musher to ever win this challenging race. Mitch crossed the finish line in Nome clocking a time of nine days, seven hours, 39 minutes and 56 seconds.  Continue reading

Telling Togo’s Tale: Togo’s Lasting Legacy…

Video filmed by Marc Heft. Edited by Jesse Tarlton.





The Iditarod was inspired by the 1925 Race for Mercy or Serum Run, during which life-saving diphtheria serum was delivered to Nome via sled dog teams. All of the dogs were amazing, including the most famous, Balto. But it was Leonhard Seppala and a 12-year old, undersized husky, named Togo, who led a team five times further than any other sled dog team over treacherous, unchartered territory. Without Togo, the villagers of Nome would likely have perished. This blog post is part of TogoRun’s campaign to tell Togo’s untold story.

Telling Togo’s Tale: Aliy Zirkle
Aliy Zirkle
Aliy Zirkle

Aliy Zirkle, in one of the more dramatic endings in Iditarod history, came in second, only minutes behind the winner. As Quito, Aliy’s lead dog, raced toward the finish line exuding confidence and speed, it’s hard not to picture Togo in a similar scene nearly 100 years ago. Just as there is the “go” in Togo, there is “no quit” in Quito, and both of these dogs are to be admired for their work and determination.

A true Alaskan and dog-lover at heart, Aliy has now raced and finished the Iditarod 13 times, with her best finishes coming in 2012 and 2013, where she placed second both times. Although she is “in it to win it,” Aliy’s philosophy about being a musher is driven by passion – her dogs. These dogs are also on a mission and possess an inner-drive that only Aliy is capable of unleashing. Continue reading