The National Health Policy Conference, this year celebrating its 15th anniversary, covers the issues that will define the policy and practice agenda in 2015. Monday's dynamic sessions revealed the intricacies and complexities of what Congress and the administration face in the year to come, but left panelists and attendees feeling optimistic about the role health services research and health services researchers could play in the policy debate.
Here, you will find a quick recap of some of the day’s sessions from AcademyHealth staff:
Administration's Plenary on Health Policy Priorities: "The Reward is Worth the Work"
William Corr, Deputy Secretary of the United States Department of Health and Human Services, kicked off the 2015 National Health Policy Conference (NHPC), noting that it's a historic time to work in the health care field. The transformation, he said, is due in large part to health services researchers, who are helping to create a foundation of research and knowledge for the administration to build upon and pave the path for advancement. Deputy Secretary Corr spent much of his session highlighting the progress made by the administration and states to move millions of Americans into health care coverage, while also noting there is still more work to be done:
"For the sake of our health, our wallets and our economy, we need to go further...We have a responsibility to lead." He told attendees that the United States isn't going to be able to fix the health care system unless we make it better and smarter, something in which individuals of all political parties and ideologies have a stake [and something we at AcademyHealth would say requires the contributions of health services research]. "We all have a stake in more access to quality, affordable health care," said Corr, adding that there was a deep commitment to building on the current health care momentum and writing the next chapter.
Plenary: State Health Policy
With the second open enrollment period closing on February 16, states continue to experiment with new innovations to expand coverage and improve access, quality and cost. This session, moderated by Dan Crippen of the National Governors Association featured Rita Landgraf, Delaware Department of Health and Social Services; Nico Gomez, Oklahoma Health Care Authority; and Brian Neale, Office of the Governor, Indiana.
Speakers discussed varying initiatives to address state-specific challenges and expand coverage in Delaware, Oklahoma, and Indiana, and they agreed that there is a great opportunity for states to use innovations to improve coverage and access. Speakers also agreed on the need to bring all of the players to the table to discuss coverage, payment, and care delivery issues and to create a lean operation and avoid duplication of effort. Nico Gomez stated “…we need to use opportunities to bring everyone to the table to make changes.”
Another important goal of state strategy that speakers discussed is empowering consumers. Landgraf giving consumers an ownership in health care so that they understand the value of health insurance and access.
This session highlighted the important role that states have in creating innovations to address changes and expansions brought on by the Affordable Care Act and the idea that states should work together to share ideas, challenges, and solutions. Brian Neale summarized the approach by saying, “When states have the opportunity to work with one another to create best practices, everyone wins.”
By leveraging multiple state resources, population health, the workforce, payers, employers, technology and more, participants believe that states can achieve success in expanding coverage and achieving the triple aim. Landgraf encouraged attendees to “look innovatively and leverage across the spectrum.”
Late Breaking Session: U.S. Health System Preparedness: Lessons from Ebola & Other Threats
Dr. Nicole Lurie, the Assistant Secretary of Preparedness at the U.S. Department of Health and Human Services moderated a panel on the recent Ebola outbreak and the state of the nation’s public health infrastructure. Dr. Lurie commented on the interconnectedness of the world and the crucial dependence on the efficiency and efficacy of the public health and health care system in order to combat public health threats.
The recent outbreak exposed healthcare gaps in preparedness procedures and day-to-day infection control processes and begs the question, “what are the roles and responsibilities of the public health and health care system in confronting threats?” Dr. Michael Stoto of Georgetown University compared the Ebola response in New York and Dallas. He asserted that, while systemic breakdowns occurred in Dallas, New York City prepared its institutions, and was able to effectively treat an Ebola case and quarantine individuals who were exposed.
Dr. Bryce Gartland, Emory University, provided remarks on the importance of adequate funding in order to sustain an appropriate state of readiness Additionally, the importance of communicating risk appropriately is key to the success of systemic response.
Dr. Jeff Levi, Trust for America’s Health, tied the perspectives together by illustrating that policymakers ramp up resources after adverse events, which eventually dwindle, weakening the necessary infrastructure— including the public health workforce; response training and resources; and the ability of the healthcare system to treat.
The ACA Punch List: Top 5 Things that Congress Needs to Fix in the ACA
The sentiment coming out of this Monday session is that the Affordable Care Act (ACA) is complicated—and panelists may argue even that is an understatement. Despite varying political ideologies and affiliations, panelists Joseph Antos, Sabrina Corlette, Jon Kingsdale, and Judith Solomon did have a common thread: a deep understanding of the health care system and how the ACA can affect it, noted moderator Timothy Jost.
Although there was some overlap between some panelists—one overlay being the dire need for the legislation’s simplification—viewpoints varied on which components were most important and in need of fixing. These ranged from eliminating surcharge rates based on tobacco use and providing plans with greater health incentives to cover more primary and chronic disease management pre-deductible (Sabrina Corlette, who focused solely on private market reform) to fixing the “family affordability glitch” (Judith Solomon) to computing different tax credits and eliminating extra plans "that serve to confuse" (Jon Kingsdale) to fixing the subsidies and eliminating the mandates (Joe Antos). Ultimately, Jost said, “Repealing the ACA is no more possible than removing the interstate highway system;” at this point, the question is how to amend it, and panelists gave members of the audience much to think about in that respect.
Lunch Plenary: Separating the Buzz from the Boon in Population Health
Elizabeth Bradley of Yale University and co-author of The American Health Care Paradox kicked off the luncheon plenary with a discussion on health care spending in the United States as compared to Scandinavian countries, and provided recommendations on what we can do to address the paradox.
Bradley compared the ratio of health care spending to social services spending in the United States and in the OECD countries: from 2000-2009, for every one dollar spent on health care, the United States spends about 90 cents. For every one dollar spent on health care, OECD countries spend two dollars on social services.
Countries with higher ratios of social to health spending have statistically better health outcomes. The difference, she suggested, can be attributed to history: in the United States, health care and social service sectors grew up from independently from one another and where as health care grew into a marketable commodity, social services were conceived of being “for the poor.” In Europe, the two sectors were knit together from the beginning.
To address this paradox, Dr. Bradley stressed the importance of debunking the popular American myth that health equals health care. By driving a culture shift on what drives health, separating health from health care, and incentivizing collaboration, we can begin to unravel the paradox of the U.S. health care system.
She highlighted the success of small, individual, champion-led programs, which led to improved outcomes for their populations and encouraged the mobilization of collaboration for health nationally. In addition, she called for common metrics for health care and social providers to measure public spending in order to report on results.
Following her presentation, Dr. Bradley participated in a panel discussion with Chris Koller, Milbank Memorial Fund and Alan Weil, Health Affairs. Koller emphasized the importance of primary care in improving population health and bridging the gap between health and social services. Weil emphasized the need for new tools and pathways to build capacity for health care organizations to do community-based, population health work.
Expanding the “Ownership” of the Social Determinants of Health
This session discussed the evolving nature of partnerships and new perspectives on the return on investment (ROI) for non-health sector investments in improving the social determinants of health, and the trans-disciplinary research required to continue to build the evidence base for action.
Dr. Ana Diez Roux, Drexel University, presented rationale for building the evidence base in order to understand the implications of social determinants of health. Dr. Diez Roux urged the audience to consider what place-based factors explain why individual characteristics related to health are spatially patterned.
Building on theme of “place matters,” Amy Gillman, Local Initiatives Support Corporation, presented the community development movement—driving investments to low-income communities to improve the quality of life for all residents. For example, in the Eastern North neighborhood of Philadelphia, an investment in several local programs e.g. a credit union, lead to a 12% reduction in poverty.
Dr. Eduardo Sanchez, American Heart Association, discussed the “upstream promotion of health” to improve the cardiovascular health of individuals, with critical attention to how an individual’s location affects their ability to establish heart-healthy behaviors. Dr. Sanchez elucidated that low education level and racial segregation contribute as equally, if not more, as tobacco use to poor heart health.
Dr. Alonzo Plough, Robert Wood Johnson Foundation, moderated the session and lead with a call to action to all stakeholders to enable every member of society to make healthy choices through greater resource equity, in order to build a culture of health.
HSR Impact Award Presentation
Day one of the NHPC ended with the presentation of the HSR Impact Award, an annual award presented to health services research that has made a clear impact on health policy and practice. This year’s award was presented to Jonathan P. Weiner, Dr. P.H., of The Johns Hopkins Bloomberg School of Public Health by Helen Burstin, chief scientific officer of The National Quality Forum, on behalf of his and his colleagues’ groundbreaking work on The Johns Hopkins ACG Case-Mix System.
This model has gained international acceptance as a standardized risk adjustment tool for health services and outcomes research. AcademyHealth congratulates Dr. Weiner and his colleagues on this well-deserved achievement.
Private Sector Health Care Transformation Plenary
Today’s final plenary examined how exactly private-sector payers, provider systems, and recent or new entrants into health care are reshaping the way care is delivered and financed.
Jeffrey Kang from Walgreens Co. discussed how his organization is responding to consumer needs through providing convenience, simplicity, and affordability. According to Kang, providing these characteristics lead to both a simple transactional relationship with a consumer and engagement in other health care channels such as digital health and chronic condition care services.
Innovative technology and technological assistance for both providers and consumers was a reoccurring theme during the plenary. David Notari of Innovation Health stated the importance of providing consumers with the tools necessary to compare prices and make firm decisions in the health care market place, an important factor in achieving better health, higher quality and lower costs. Aparna Higgins, AHIP, further built on this theme by explaining that giving providers data on patients is critical to helping them better manage their practices as well as exchanging health information through access to online portals.
This session was moderated by Susan Dentzer from the Robert Wood Johnson Foundation.
Adjunct Meetings and Day Two
This evening's adjunct meetings include:
- Student Networking Event6:30-8:30 p.m. | President's Sports Bar & Grill | Renaissance Washington, D.C. Downtown Hotel
- Disparities Interest Group Networking Happy Hour7:00-8:30 p.m. | Penn Quarter | Renaissance Washington, D.C. Downtown Hotel
Tomorrow morning's adjunct meetings include:
7:30-8:45 a.m. | Renaissance West | Renaissance Washington, D.C. Downtown Hotel
7:00-8:45 a.m. | Renaissance East | Renaissance Washington, D.C. Downtown Hotel
We will update this post with links to presentations as they become available. In the meantime, we hope you enjoy your second day of the NHPC. Be sure to follow us and add to the conversation on Twitter @AcademyHealth, #nhpc15.