The last day of the AcademyHealth Annual Research Meeting wrapped up with a half day of presentations that included the Best of ARM: Part Two and a late-breaking abstract session on the early performance of the Affordable Care Act (ACA). Although it's hard to believe another ARM has come and gone, we leave energized about the amazing work that people in our field are producing and its potential to positively shape the U.S. health care system.
Best of ARM: Part Two
Today's Best of ARM: Part Two session highlighted high-level research findings worthy of further discussion. Expert discussants Tom Ricketts, David Auerbach, and Donald Taylor broadened the implications and meanings of the papers.
Conducted as a collaborative discussion, Rickets, Auerbach, and Taylor each provided their analysis among the abstracts Failing to Choose Wisely: Lack of Treatment De-intensification in Older Patients with Diabetes; Nurse Value Added and Patient Outcomes in Acute Care; The Changing Role of RNs in Pioneer ACOs; and How Do Health Policy Researchers Perceive and Use Social Media to Disseminate Science to Policymakers? They then welcomed the abstracts' authors to the stage to continue the conversation. Audience members were encouraged to ask questions of both the discussant and the author. Some of the Q&A session addressed challenges and opportunities of using big data warehouses, the role of the media in study titles, the idea of "good nurses," and differences in magnet vs. non-magnet hospitals.
Late-Breaking Abstract Session: The ACA and Early Performance
The following late-breaking abstracts chosen for this special session discussed early evidence and experience associated with the Affordable Care Act (ACA):
- Consumers’ early care experiences using Health Insurance Marketplace qualified health plans: Preliminary findings from CaliforniaBrandy Farrar, American Institutes for Research
- ACO Characteristics Associated with Quality PerformanceTaressa Fraze, Geisel School of Medicine
- Early Impact of Affordable Care Act Subsidies on Labor Market SupplyCameron Kaplan, University of Tennessee Health Science Center
- Experience with ACA Open Enrollment: Lessons for 2015Stephen Zuckerman, Urban Institute
Zuckerman kicked the session off by describing the ACA’s open enrollment and discussed its implications for 2015. Key among his findings were that costs were often perceived as a barrier for uninsured adults seeking coverage. Using 2014 as an indicator, there are many things to take into account for 2015's open enrollment. Improving health insurance literacy may encourage participation and improve the ability of consumers to make informed choices; even if you build it, people may not come (many uninsured aren’t ready to obtain coverage, and some may question its value); and some people merely need people to help them, not just websites.
Kaplan’s work demonstrated that the way subsidies are designed may lead to labor market impacts. Based on preliminary analysis, estimated health insurance subsidies were associated with decreases in hours worked, and impacts were significantly greater in places with higher health insurance premiums.
Following the presentation of Kaplan's work were Farrar and Fraze, who discussed Californians' experiences using the state's marketplace and emerging trends in Accountable Care Organizations (ACOs) and potential narratives as to why they're occurring, respectively. Their work is not yet available for public distribution.
Update on Federal Payment Reform at CMMI and Responses from the Marketplace
This session focused on new payment models and reflected how the changing landscape of federal payment reform is influencing current and future programs in the marketplace. Moderated by William Shrank, this panel provided insight into how large health insurers and provider organizations are succeeding in their reform efforts and introduced new progressive payment models.
Randall Krakauer from Aetna discussed a model that awards value over volume; it focuses on collaboration and aligns resources and incentives to improve outcomes, creating greater value for patient and provider organizations. Additionally, Krakauer stressed the importance of both clinical and economic value to identify factors like return on investment. Danielle Lloyd, Premier Inc., also introduced a model, known as the quest collaboration model. Quest collaboration stresses not only the importance of collaboration among patients and providers but mines data to identify opportunities and build tools such as webinars and training in order to achieve goals.
The Pathway Toward Value: Building on Cost and Quality Measurement
In this panel, speakers explored the pathway toward measurement of health care quality and value. Moderated by Helen Burstin, this session included three panelists who discussed the best practices available to bring cost and quality measurement together in order to achieve efficiency.
Dana Safran introduced the Alternative Quality Contract (AQC), a model characterized by its population-based budget, quality incentives, sustained partnerships, and long term contracts. Jill Yegian proposed health plans with shared savings and the implementation of value-based pay, while the panelist Arnold Millstein of Stanford University recommended a systematic structure based on care control in order to appraise the success of new and innovative measurement models.
Spreading Evidence-Based Practices: Collaboratives, Campaigns, and the Law
During this session, chaired by Sarah Krein and Caroline Logan, call for papers panelists Andrew Garman, Hangsheng Liu, M. Susan Ridgely, and Eric Schneider shed light on how research findings can help shape medical practice for the better. Liu and Garman’s work related to central line-associated bloodstream infections (CLASBI), while Ridgley and Schneider’s presentations discussed various aspects of the Institute for Healthcare Improvement’s (IHI) Project JOINTS (Joining Organizations IN Tackling SSIs) campaign.
Garman and his colleagues worked off the Agency for Healthcare Research and Quality’s focal question, “When it comes to CLASBI reduction, why are we seeing better results in some places than in others?” Their study found that the most successful sites tended to have a physician acting as a champion, had education and required training built into the system, instilled a culture of "zero" as a goal, and there was clear “ownership” among front-line staff. Although getting to “zero” CLASBI infections is difficult, the team’s recommendations for sustaining “zero” are for hospitals to develop a sustainability plan, continue to monitor and improve, remain vigilant with bundle compliance, educate and retain staff, and focus on a safety culture.
In the Project JOINTS campaign, IHI developed a network of state-level organizations that already had existing relationships with hospitals that could then be connected into a “node network.” The idea behind the Rapid Spread Network (RSN) is that, when the need for a campaign arises, there’s an established network already built to help hospitals catalyze quality improvement.
Discovering Factors that Make Health Care Teams and Organizations Great
This session focused on five studies, which identified qualities and characteristics that allow health care teams to be both successful and productive. Abstracts covered a variety of methods in diverse settings including the VA in Michigan, public hospitals in New York city, cancer centers within safety-net hospitals and more. Each presenter highlighted how findings could be applied to other settings. A common theme throughout each abstract was the importance and necessity of communication, clarification, and collaboration among team members.
Cost and Quality of Maternal Care
"How much did the most expensive birth in Great Britain cost?", Kate Kzhimanni, University of Minnesota, asked the audience at the beginning of her presentation. The birth of Prince George, she said, cost around $15,000, roughly $3,000 more than the average vaginal birth in the United States. This statistic, along with others, is why the cost and quality of maternal care was a topic at this year's ARM.
Laura Attanasio from the University of Minnesota spoke about midwifery care and how her research found that this type of care appears to facilitate better patient-provider communication. Amy Graves from Vanderbilt University Medical Center presented on a paper titled, The Impact of Transition to a High-Deductible Health Plan on Contraceptive Use and Birth Rates, and Katy Kozhimannil from the University of Minnesota, presented research from two papers: Birth Volume and the Quality of Obstetric Care in Rural Hospitals and Potential Benefits of Increased Access to Doula Support during Childbirth. Lastly, Xiao Xu from Yale University presented on the cost of maternal care during childbirth and the variations across U.S. hospitals. (Not all studies presented are available for distribution.)
While each presenter noted a number of limitations that prevents researchers from knowing all of the answers, each presenter acknowledged the fact that this research is a step forward in the right direction to determine how we can make birth better for our health and our pockets.
Scroll through the #ARM14 conversation on Twitter too see which insights people shared from various sessions, and visit the AcademyHealth website to view presentations from throughout the conference. Also, please share your key takeaways from the meeting on our social networking site my.academyhealth.org so the learning doesn't have to end just yet!