The 2014 Annual Research Meeting (ARM) got off to a strong start today, as more than 2,400 of the brightest minds in health services research gathered in San Diego for an agenda full of innovative and exciting content. Some themes coming out of the first day's sessions relate to the ever-changing nature of the United States health care system and, as part of that, the need for researchers to continue expanding their research methods, strengthening their relationships, and building new partnerships.
Here, you will find a quick recap of some of the day's sessions from AcademyHealth staff:
Dr. Harvey Fineberg: Health Services Research and a Learning Health System
Dr. Harvey Fineberg delivered the keynote presentation on the critical nexus of health services research and a learning health system. Learning health care systems, he noted, are continuously committed to improvement: they are engaged in discovery, innovation, and implementation, which aligns closely with the goals of health services research. Integrating this research in a learning health care system will bring health and health care closer in alignment so that health care serves the interest of improving health over time.
In his keynote, Dr. Fineberg identified the following three themes that will be increasingly important in the future:
- Embed Research into the Process of Care
There is a need to make research and the delivery of care intrinsically inseparable, Dr. Fineberg said. Technological advances within the delivery process help researchers and clinicians engage more rapidly in the gathering and analyzing of health services research data over time. Gradually, the delivery of care and the organization of health systems will need to be improved so the data related to clinical care is accessible and usable for research. We, as researchers, he said, need to work more closely with our clinical colleagues so that more clinicians become health services researchers and more researchers can become clinically aware.
- Strengthen Our Alliance with Patients
Dr. Fineberg identified new metrics to determine the success of health services research. Instead of judging the academic success on publications, he said, we should measure success based on patient impact, outcomes, and care delivery.
- Build Bridges with Allied Professionals
Health services researchers need to build bridges with allied and relevant fields, such as engineering. This community can gain insight and innovation from collaboration with different disciplines.
Concluding with a question and answer session where he addressed paradigm shifts in the community, Dr. Fineberg noted that in this field, uncertainty is part of our daily lives. It is through research that we can decrease that uncertainty, but more importantly, help to clarify and improve our choices. And after all, the goal of research is to inform choice.
Beyond Peer Review: Packaging Your Work for Different Audiences
AcademyHealth Vice President for Strategic Communications Kristin Rosengren moderated a discussion that examined the relationship between researchers and policymakers, and the opportunities and challenges of communicating evidence via various media outlets. During the session, panelists Elizabeth A. McGlynn, Ph.D., and Austin Frakt, Ph.D., shared insights on working with reporters based on their own experiences with traditional and social media, while journalists Chad Terhune, Los Angeles Times, and Dan Diamond, The Daily Briefing, explained what makes a good source and an appealing news story. Audience questions added depth to the discussion, digging into reasons researchers might be hesitant to go on the record, ways to address it and the potential career implications of media exposure.
Drawing on the discussion, Dan and Austin whipped up a quick summary of lessons.
Late-Breaking Abstract Session: Coverage in the Era of the ACA
This session, comprised of abstracts submitted to a special late-breaking call for abstracts, discussed the most recent findings on health insurance coverage under the Affordable Care Act (ACA). Moderator Alan Weil, Health Affairs, noted that the theme of all five papers was a look ahead to the rollout of the ACA and the need for answers to questions that "normal methods" would not immediately answer. Authors thought creatively about data sets and analytics to provide immediate answers on ACA implementation.
Papers, panelists, and findings included:
- A Promising Start: Early Estimates of Changes in Health Insurance Coverage Under the ACASharon Long, Urban Institute
The findings from the HRMS provide early evidence of the gains in insurance coverage under the ACA as well as an indication of populations that may be lagging behind as the ACA moves forward.
- Increasing Preventive Care with Expanded Medicare Coverage Under the Affordable Care ActSukyung Chung, Palo Alto Medical Foundation Research Institute
This study found that increased coverage led to increased utilization of preventive visits and services but that Medicare enrollees still have lower utilization of these visits than those with other coverage.
- Comparing Estimates of the Uninsured with Health Insurance Marketplace EnrollmentEmily Gee, U.S. Department of Health and Human Services
This study will characterize the demographic and geographic distribution of America's uninsured potentially eligible for coverage expansion under the ACA and compare it to that of enrollees in the Health Insurance Marketplace. The team has collected data through April 2014.
Two additional authors presented preliminary data not yet available for release, including Early Estimates of Changes in the Uninsured Rate for 2014: Preliminary Findings from the Gallup Healthways Well-Being Index by Benjamin Sommers, Harvard University and Tracking Early ACA Coverage Expansion Impacts in Pharmacy Transaction Data by Andrew Mulcahy, RAND.
Innovations in Engaging Patients and Caregivers in the Research Process
During this session, chair Marc Boutin and panelists Dan Mullins, Jean Slutsky, and Jonathan Tritter stressed the need for researchers to understand the context of patients' situations. Involving patients and caregivers in the research process affects how people perceive their value of care, and patient engagement in the research process is one such way to shape that perception.
Panelist Dan Mullins put forward three practical methods, echoed by other panelists, for engaging with patients. First, researchers must partner with other individuals and organizations to reach patient communities. To make a connection, they must realize they can't go it alone. Second, researchers must meet people where they are, whether geographically, mentally, or emotionally. Patient engagement is not a one-size-fits-all process, but it should be a continuous process, and the pre-engagement component is critical. Finally, researchers should use media, both the big media and targeted media, to reach audiences and convey key messages. When used in the right way, these methods can help build trust -- a critical component as emphasized by each panelist. As Tritter said, "In patient-centered outcomes research, you often have to wonder if it's not about the difference in outcome, but the difference in process that really matters."
Early Observations from Accountable Care Organizations Developing in the Private Market
With over 500 Accountable Care Organizations (ACOs) in the United States today, this organizational structure is clearly catching on at a rapid pace. Understanding the impact they are making and learning from their experiences is important to move ACOs forward and help them succeed.
This session, moderated by Andrea Ducas from the Robert Wood Johnson Foundation, shared governance factors and payment arrangements for a number of ACOs, but panelists Kristin Harding, James Maxwell, Paula Song and Jill Yegian agreed there were six common lessons learned: 1) hospital involvement is still low; 2) there is a lack of patient awareness (in other words, patients may not be aware they're being treated by an ACO); 3) innovation is brewing due to increased data availability; 4) "It takes money to save money," and though it may be difficult to make investments upfront, those investments will save money in the end; 5) transformation takes time; and 6) there is no one-size-fits-all approach for ACOs.
ROI for Whom? Assessing the Value of Prevention from Multiple Stakeholders
The Robert Wood Johnson Foundation's Alonzo Plough moderated a panel of three experts who discussed issues related to the cost and value for public health with a particular focus on the return on investment (ROI) of nonclinical interventions, cost benefit, cost savings, and cost effectiveness. All three panelists discussed the challenges with methodology, economic evaluations, the quantification of financial health impacts of prevention, and translation to policymakers at the state, local, and private levels.
Within the session, panelists also discussed different methods for evaluation. Among these methods were using an ROI analysis model that focuses on financial costs and the time frame for a risk free rate of return on capital (from panelist Scott Grosse) and an analysis tool that is able to assess and communicate the value of nonclinical primary prevention and its impact on health care costs (as discussed by panelist George Miller).
How Do We Meaningfully Solve the Primary Care Shortage?
This session featured four speakers addressing the different aspects of the primary care shortage, and David Auerback, RAND, acted as a discussant, reacting to their presentations. Scott Shipman, Association of American Medical Colleges, discussed how changing the workday of providers can reduce inefficiency and waste. He suggested focusing on teamwork, workflow design, and technology. Addressing the teamwork aspect of Shipman's suggestions, Rachel Willard-Grace, University of California, San Francisco, presented research on using non-licensed health professionals (such as community health workers and medical assistants) to implement new models of care. Terhilda Garrido, Kaiser Permanente, spoke to the technology component and revealed how electronic health records (EHRs) and secure emails can optimize provider workflows and help providers use time more efficiently. Finally, Ateev Mehrota discussed five ideas to reduce the primary care shortage: discourage annual physicals; have others manage simple-acute issues; rationalize variation in follow-up visits; utilize Nurse Managed Health Centers; and provide care outside of face-to-face visits.
The presenters suggested that, moving forward, policymakers, researchers, and health professionals focus on how we can reduce the barriers that are currently preventing new solutions from being implemented.
Innovation Station Highlights Innovators at ARM 2014
The Innovation Station, a meeting and collaboration space at ARM, opened its doors Sunday with presentations from a number of dynamic (and of course innovative!) speakers. With a combination of presentations and an interactive Prezi, the Innovation Station profiles new tools, data, and methods, as well as approaches to translation, dissemination, and implementation. Here’s a quick snapshot of each presentation:
- Anne-Marie Audet from the Commonwealth Fund, shared their new “Breakthrough Health Care Opportunities” program that is focused on discovering and vetting breakthroughs in health care delivery. She engaged ARM attendees in a discussion of opportunities in translating innovations from other fields, reinventing older models, and leveraging interdisciplinary collaborations and networks.
- Philip Payne, from the Ohio State University, demonstrated their CIEHLO platform (Collaborative Informatics Environment for Learning on Health Outcomes) which provides researchers with access to an open-source “app store” for data analysis and software sharing.
- Mark Danese and Jennifer Duryea, from Outcomes Insights, Inc., demonstrated a new approach to organizing electronic data for research, Cohort Jigsaw. Cohort Jigsaw is aimed at helping researchers understand and manipulate raw data, identify methods for answering clinical research questions and building cohorts in a methodologically sound and user-friendly way.
- Michael Seid, from the Cincinnati Children's Hospital Medical Center, described the C3N Project, a collaboration with the ImproveCareNow (ICN) Network, which has created a prototype for a network-based learning health system. This project was developed with active engagement from patients with inflammatory bowel disease (IBD) and their families. Based on its success, they are planning to scale this project up for other chronic diseases.
There's still a day and half of presentations to come and we'll update this post with links to presentations as they become available. In the meantime, we hope you enjoy your second day of the ARM. Be sure to follow us and add to the conversation on Twitter @AcademyHealth, @phsr_ah, and @edm_ah.