As many of you already know AcademyHealth is the professional home for the producers and users of health services research – the science that determines what works in healthcare, for whom, at what cost, and under what circumstances. Our members study how our health system works, how to support patients and providers in choosing the right care, and how to improve health and health care delivery, through the use of evidence in decision-making.
Which is, of course, what brings us here today. The National Health Policy Conference was born of our mission to move evidence into action, and we dedicate this time each year to understanding what health policy questions will take priority in the year ahead, and what evidence exists to help us understand the problem and its possible solutions.
For the last eight years, these discussions have been dominated by the development, passage and implementation of the Affordable Care Act; and we’re already seeing that 2017 will be marked by consideration of the possible approaches to its repeal and replacement. But these discussions don’t happen in a vacuum. The environment in Washington, in the states and in our communities affect health and health policy in myriad complex ways. And, let’s be frank, the environment in Washington right now is VUCA – Volatile, Uncertain, Complex and Ambiguous.
Many of you are probably familiar with the term VUCA, it is not of my invention. In fact, it’s been in common use since the 90s, drawn from military parlance, it is increasingly being applied as a model for private sector strategic management. My staff will tell you we’ve been talking about what it means to operate in a VUCA environment a lot lately, and I think it’s an important frame for how we’ll approach the next few days.
As an example, when my communications lead and I completed what we thought was the final draft of these remarks just 48 hours ago, we were considering the role of evidence on a list of other, non-ACA challenges confounding the nation. Things like the continued struggle to improve patient safety, address persistent and pervasive health disparities and stem the rise of mortality rates, drug prices and the opioid epidemic. But that was Friday. By Saturday, I knew I could not address you today without acknowledging the fact that immigration policy, in a very real way, is and will be a health policy issue affecting all of us in 2017. Whether it be the impact of changes on the visa status and free travel of our international peers and collaborators, or delays in discovery and impact on direct patient care that stem from physicians and scientists unable to train, or return to active practice in the United States.
I wrote in a Health Affairs blog published last week that an important question for all of us at AcademyHealth is whether and how evidence from research will inform a new era of health policy debates. This week, I think the question is more about how the health care and health policy community can continue to positively contribute to the development of sound policy in a volatile, uncertain, complex and ambiguous environment.
If you know AcademyHealth, you know that evidence is our North Star. So it won’t surprise you that my answer is still grounded in the need for evidence.
Together with our nearly 4,000 individual and organizational members, we work every day to ensure that individual and collective decisions take evidence, statistics and facts into account.
Whether it is a private conversation between a doctor and her patient about which treatment is right for him, a discussion amongst the C-suite of a hospital about how to improve their ratings on hospital compare, a debate in a state house about state licensing laws and prescribing privileges for nurses and psychologists, or the very public debate this country is now having on the ACA, we believe that individuals and communities - and this country - will be made healthier by taking evidence into account. We know that rigorous, timely evidence is critical to a robust and just policy process.
Take for example the work of some of our HSR Impact Award winners – science that helped inform policymaking and improve outcomes for the American people.
In 2011, we recognized the work of Terry Tanielian and colleagues from the Rand Corporation, who conducted the first and only large-scale, nongovernmental assessment of the psychological needs of Iraq and Afghanistan veterans. Their work led to policy action by members of Congress, the Department of Defense, the Veterans Administration, and other stakeholders, and improved access to behavioral health care for returning U.S. service members. Evidence improved care for our nation’s veterans.
In 2013, we recognized the Oregon Health Insurance Experiment, a unique opportunity for a randomized controlled trial, led by Amy Finklestein and Kate Baicker that helped understand the costs and benefits of expanding Medicaid at a time when states were making choices about whether and how to expand coverage under the Affordable Care Act. Evidence helped state policymakers understand a complex set of choices in a highly partisan environment.
And in 2014, we celebrated research from Richard Hirth and colleagues that contributed to the development of a prospective payment system that the Centers for Medicare and Medicaid Services used to reduce costs and improve the quality of care for patients receiving dialysis for end stage renal disease – patients who make up 1 percent of the Medicare population but more than 6 percent of Medicare spending. Evidence helped improve the patient experience, and reduce some costs.
And later today, we will be recognizing the 2017 Impact Award winner, Dr. Ben Sommers for a body of work that helps us understand the effects of various provisions of the ACA. Dr. Sommers’ finding are even more important today, as we debate the relative merits and risks for any number of proposed approaches to repeal and replace the Act. This evidence matters.
As we reflect this week on the volume and variety of issues under discussion at the state and federal level, and among health care payers and providers, these award winning research projects remind us of the importance of reliable, independent, and accessible evidence and data. Evidence that requires a sustained commitment of federal support as a critical component of our nation’s commitment to science and improving the health and wellbeing of our population.