On September 27, AcademyHealth hosted its first Hill briefing in five years, “Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality.” Filled with congressional staffers, health services researchers, and members of the media, this briefing sought to educate policymakers and their congressional staff about how health services research can help reduce the deficit, which is especially relevant in light of a looming sequester.
The panelists for this event were Dr. David Atkins, U.S. Department of Veterans Affairs; Dr. Peter Pronovost, The Johns Hopkins University; and Dr. Joe Thompson, Surgeon General of Arkansas. Bringing in different perspectives, each of these health system leaders demonstrated how, in a time where health care costs and the value of the U.S. health care system are under increased scrutiny, health services research can provide immense benefit.
Central to this briefing was the key message that health services research is a worthy investment and something deserving ongoing commitment in Washington.
Dr. Lisa Simpson, president and CEO of AcademyHealth, began by pointing out something many decision makers had heard before: that 30 percent of health care spending is waste. But challenged the assembled crowd with the question that really matters: which 30 percent? Health services research, she argued, can tell us. Health services research exposes the critical challenges that confront the nation’s health care system and then develops and tests ways to address them so that public and private sector services and programs can be evidence-based.
Building on Dr. Simpson’s point, Dr. Atkins discussed five health services research questions that can guide national efforts to improve quality and value of our health care system, and gave one example of how those questions have been applied in the VA health system. The questions were:
Dr. Atkins’s example of health services research as a means to transform the health care system dealt with the mental health of U.S. veterans. Serious mental illnesses, including Post-Traumatic Stress Disorder (PTSD), depression and bipolar disorder affect one in four veterans. Not only were so many veterans affected, but there were also several challenges limiting veterans’ ability to receive treatment including challenges accessing health care as well as engaging in and staying involved in treatment. Further, there was a lack of coordination across medical and psychiatric providers. To address these issues, the VA developed and implemented new models of care, an example of which is the Collaborative Chronic Care Model (CCM) to test the extent to which better connections between primary care to mental health care would result in improved outcomes. After six months, the outcome of collaborative care was that 82 percent of patients were able to be treated for depression in primary care, and 89 percent have remained in care. Thirteen studies on the collaborative care model also showed improved health outcomes at comparable cost to regular care.
Dr. Pronovost of the Johns Hopkins University began his quest to improve the quality of the U.S. health care system after the death of Josie King, an 18-month-old girl who died from complications after an infection from a catheter insertion. Challenging the prevailing attitude that some number of infections were simply to be expected, Dr. Pronovost believed that more could be done to prevent deaths like Josie’s. Through research, Dr. Pronovost’s team developed and tested a checklist using five of the most basic principles in the Centers for Disease Control and Prevention’s guidelines, such as washing hands, covering the patient, and asking if the catheter was still needed. Rather than simply telling employees to improve compliance, the research team created a new system. By placing all essential items for catheters in a line cart, removing unnecessary effort to pick-up this equipment, and involving the nurses in the process, compliance rates went up to 98 percent. In the first three months of the study, Michigan’s intensive care unit’s infection rate went down by 66 percent. Dr. Pronovost noted that a simple $500,000 grant from the Agency for Healthcare Research and Quality for his team’s study is now saving 2,000 lives and $200 million annually in Michigan hospitals. Applied to all 50 states, checklists could have an even greater effect.
Finally, Dr. Thompson offered a state-based perspective on how research findings have helped Arkansas understand the challenges its population faces and design new approaches to improving health and health care. Arkansas is making its transformation through: 1) results-based payments and reporting; 2) health care workforce and development; 3) health information technology (HIT) adoption; and 4) expanded access for health care services. Within this conversion is the assigning of “quarterbacks,” or principle account providers, to manage the “team” of health providers and, simultaneously, provide better care to patients. For example, in hip replacement procedures, the orthopedic surgeon would act as the quarterback and—as part of that role, would handle patient claims from 30 days prior to 90 days after the procedure, ensuring a smooth transition for recipients of the surgeon’s care. Currently, Dr. Thompson noted, there are too many teams in health care with no true quarterback to coordinate care. Through efforts like this, health services research-informed interventions are expected to reduce cost increases from 7 percent per year in Arkansas to 2-3 percent per year. After the briefing, Politico Pro featured an article about Arkansas’s efforts at system transformation. (Please note: a subscription is required to view the article.)
Today’s political environment is fraught with partisanship, concerns about the federal budget and national deficit, and misunderstandings and disagreements about what should be done to return our country to a balanced budget and reduce the deficit. Effectively addressing health care costs’ contribution to this fiscal crisis is critical. This panel made clear that it is possible to improve the quality and safety of care, and reduce its costs. The briefing also illustrated how taking the time to move research into policy and practice can have important effects on both an individual and a nationwide level. As policymakers grapple with how to reduce the nation’s national debt and deficit, they should increasingly look to health services research for answers to tackle health care.
- Where is there room to improve quality/lower costs?
- Why do gaps in quality of care exist?
- What new models of care can improve quality?
- Will the new model of care provide good value?
- How can we spread effective models or interventions to more patients, more quickly?