The Annual Research Meeting continued on Monday, June 15. We are excited by the new and innovative research that was presented and discussions that occurred at the meeting. We are energized about the groundbreaking work that those in our field are producing and its potential to positively shape the U.S. health care system.

What Do Medicaid Policymakers Say They Need from Researchers?

This session, moderated by AcademyHealth senior director, Michael Gluck, explored the second in a series of Listening Project reports released by AcademyHealth in February 2015. The session began with an overview of the report entitled, “The AcademyHealth Listening Project: Improving the Evidence Base for Medicaid Policymaking”, by AcademyHealth senior manager, Lauren Randomski. Fellow panelists included, Catherine Hoffman, California Medicaid Research Institute, Lucinda Jesson, Minnesota Department of Human Services and Anne Schwartz, Medicaid and CHIP Payment and Access Commission.

Randomski explained the premise of the report, which is that if research is to be useful the first step is to look at the right questions. To answer these questions, the research team interviewed federal and state policymakers, analysts and national associates. According to Randomski, results of the report show that better understanding of access to care, quality of care, and health outcomes are needed.

Following the overview, panelists presented related findings and information. Schwartz shared thoughts on Medicaid and Medicare research overall, while Jesson discussed ongoing efforts in Minnesota and Hoffman detailed three key messages related to research: 1. Tricky Business, 2. We Need Results….um…yesterday and 3. What it Takes to Free the Data.

The panel closed with a discussion around the fact that Medicaid research is challenging, but worthwhile and rewarding.

To read the full report, visit the AcademyHealth website.

From Vision to Action: Measures to Mobilize a Culture of Health

This session, moderated by Alonzo Plough, focused on the Robert Wood Johnson Foundation’s (RWJF) framework for a culture of health, or a society in which everyone has the opportunity to live the healthiest life possible. Panelists discussed three research programs solicited by RWJF to examine the factors necessary to implement the framework, including “evidence for action, policies for action, and systems for action.

Nancy Adler from the University of California San Francisco began the panel by calling for health care systems to take on additional roles and responsibilities to improve health care disparities. Glen Mays of University of Kentucky, College of Public Health, then further explained the idea behind “systems of action,” which seeks to widen lens of HSR-focus more at the intersection of sectors and stressed the importance of linking people to needed health and social support services as a core function of public health. Lastly, Scott Burris of Temple University-Law School posed the question of how to best use research to “drive into police” and how to engage and “make sense of research across disciplines.

Advancing the Field of Dissemination and Implementation Research

Dissemination and Implementation Research, or D&I, may vary based on research discipline or by the institution funding the research. Regardless, it’s essential to improving health, said David Chambers, National Cancer Institute. D&I research is not a new phenomenon; it’s been around for decades—in work around effectiveness and efficiency, practice variance and safety, and evidence-based medicine—and centers on asking how we can apply what we know to try to improve health and health care of populations.

Unfortunately, there is a long uptake between policy and practice. Chambers mentioned that it takes 17 years to turn 14 percent of original research to the benefit of patient care. “If we ignore all we learn about how we get the information out there and if we focus on publication as the Holy Grail,” he said, there are “many important findings we lose and that don’t see the light of day.” Yet, there is a silver lining: there are increasing opportunities from AHRQ, CDC, NIH, PCORI, WT Grant Foundation, and many more. Areas that are ripe for exploration include sustainability of evidence-based practices in changing context and their adaptability over time; implementation of a set of interventions; impact of dissemination strategies on practice; and scaling up practices across health plans, systems, and networks.

Panelists noted that even the thinking around D&I research has progressed; researchers are now trying to think more sensitively about context—to population and community health systems—than they had previously. Felica Jones and Kenneth Wells demonstrated this by describing their work with minority communities, where their work centers on efforts to build trust and conduct community-based participatory research. As they noted, it’s not just about the research; it’s about documenting and improving health care capacity, and there’s a social justice aspect to the work.

As closing advice for attendees,the panel suggested they pay better attention to the implementation that is taking place all the time in a number of different settings because that is where researchers can find myriad opportunities.

Presenting Research in Compelling Ways: A Student Competition (Translation and Communications Interest Group)

Monday wrapped up with the second annual student competition, sponsored by the AcademyHealth Translation and Communications Interest Group. In this year’s competition, four students presented on the 2014 Article of the Year, Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market. Health Services Research, by Austin Frakt.

The session, chaired by AcademyHealth’s current Innovator-in-Residence Felicia Mebane, featured four interactive presentations by Jaya Khushalani, Chelsea Lyons, Wafa W. Tarazi, and Bill Wovwod. The students all had seven minutes to present on Frakt’s paper and were challenged to do as if the audience had no expertise in health care. Both judges and the audience picked Wafa Tarazi as the winner. Judges commented on the importance of using personal connections and vivid imagery in order to engage others.

Rapid Validation: Turning Ideas into Actions and Outcomes

Monday’s lunch plenary presentation speaker was Roy Rosin of Penn Innovations. Rosin's presentation covered the history of innovation and outlined a framework for high impact innovation and practices that result in rapid validation of new ideas. These strategies for innovation included the following:

  • Vapor Testing: If your product is based on an assumption that people need the product, then contextually test demand.
  • The Fake Front-End: Ask the question what would happen if someone interacted with this? Will people do with it what I think they will?
  • The Fake Back-End: When a big assumption depends on how a consumer will use the product or idea, use a fake back-end to go from ideas and pitching to actual evidence.
  • The Mizner or Mockingbird: If you have an idea, but others like it exist, test it out and gauge whether it is that much better than the perceived competition.
  • The Pre-Pilot: Gather as much evidence and data as you can to pilot before a product launch.

Noting that 93% of all innovations that ultimately succeed start in the wrong direction, Rosin emphasized the need for early validation to enable people to move quickly from idea to action.

Best of ARM: Part 1

This session featured three abstract presentations and two discussants who commented on specific components of the presentations.

Romana Hasnain-Wynia put the abstracts into context by identifying an underlying theme. While the three presentations focused on distinct and differing topics, the common thread among them seemed to be that health care is shaped by multiple interacting factors, and that factors outside of the clinical setting can have a huge impact on health outcomes. The panel also commented that the United States is trying to achieve a multi-sectoral health system and must understand how the health system is impacted by the entire community.

Abstracts included:

  • Public Housing “Hot Spots”: Identifying Low-Income Neighborhoods with the Highest Health Care Use and Costs

    Katherine Neuhausen, Virginia Commonwealth University, Richmond, VA

  • Variation in Process and Priorities Between Local Health Department and Hospital Led Community Health Assessments

    Scott Frank, MD, MS, United States, Case Western Reserve University School of Medicine, Cleveland, OH

  • Using Multi-Stakeholder Alliances to Reduce Hospital Readmissions: Preliminary Findings from an Evaluation of Aligning Forces for Quality (AF4Q)

    Philethea Duckett, MPA, Northwestern University, Chicago, IL

Commentators Ann Beal and Michael Stoto placed the research into context and offered other lenses in which to interpret the results. Stoto emphasized the need for new and continued partnerships between the public health and clinical fields. Beal highlighted the need for researchers to be both rigorous and relevant. “All research, when it’s really good,” she stated, “leads to more questions than it answers.”

Innovations in Preventing Avoidable Readmissions

This session, moderated by Lucy Savitz of Intermountain Healthcare, discussed new innovations available to prevent avoidable hospital readmissions all while improving safety, quality, and care.

Rachel Henke, Truven Health Analytics, explained that hospitals at risk for readmissions should focus on improving patient discharge planning to reduce their readmission rate and improve their capture rate of patients who are readmitted. Next, Chuan-Gen Liu, Center of Innovation for Veteran-Centered and Value-Driven Care, presented results that identified clinical practices that could potentially reduce heart failure specific readmission while Philethea Duckett of Northwestern University called for further research to explore the advantages and limitations of the multi-stakeholder alliance model to reduce readmissions. Jennifer Polinski, CVS Health, presented two medication reconciliation programs which significantly reduced the likelihood of 30-day readmissions among high-risk patients and produced significant net savings. Lastly, Mark Unruh of Weil Cornell Medical College presented a study suggesting that hospital participation in Meaningful Use may decrease costly readmissions and improve the quality of care for Medicare beneficiaries.

Best of ARM Part 2

John Graves of Vanderbilt University moderated this session, a perfect end to ARM 2015, discussing some of this year’s most intriguing and innovative research.

  • The Long-Term Health Effects of Early Life Medicaid Coverage

    Laura Wherry

    University of California, Losa Angeles

    Presented by Benjamin Sommers, this study examined the association between Medicaid prenatal eligibility and later life adult health for individuals born between 1979 and 1993. The study found that there is a negative association between prenatal eligibility and certain adult health outcomes and that Medicaid coverage decreases the probability of early childhood obesity.

  • Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces?

    Sophie Beutel

    The Commonwealth Fund

    This study explored a key question following the first few years of the Affordable Care Act: “Are coverage marketplaces filling the gap to make sure all Americans have access to health insurance?” Results indicated that subsidized coverage for people with low incomes were effecting in making individual market coverage comparable with employer-based health benefits in terms of affordability and protection from out-of-pocket costs.

  • The Effects of Adult Medicaid Expansions on Mental Health Services Utilization and out-of-Pocket Spending for Mental Health Services

    Ezra Golberstein, University of Minnesota

    Results from this study suggested that Medicaid expansion could potentially benefit individuals with mental illnesses because due to its capacity to significantly reduce out-of-pocket spending for mental health services. Additionally, the study suggested that expanding Medicaid could affect the most severe mental health and substance abuse disorders and positively affect behavioral health.

These Best of ARM papers were presented by discussants John Graves of Vanderbilt University, Benjamin Sommers of Harvard University, and Tami Mark of Truven Health Analytics.

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