Featuring perspectives from a host of speakers reflecting a wealth of experience in health policy implementation and assessment - from the U.S. Surgeon General and the Democratic Whip to health policy reporters and leading academics - the National Health Policy Conference (NHPC) emphasized a call for a focus on evidence building to inform policy debates and decisions.
AcademyHealth President and CEO Lisa Simpson opened the conference with a call to “elevate the debate, to move us beyond partisan rancor and tropes to real solutions.” This sentiment was echoed throughout the conference. From former Wisconsin Medicaid Director Michael Heifetz at the opening plenary: “We’re interested in what’s best for everybody not just what’s best for Republicans or Democrats.” In the closing plenary on misinformation panelists noted the responsibility to protect the integrity of the research and evidence that affects the most vulnerable among us.
“You don’t have to be a producer of misinformation to be a victim of misinformation,” MIT’s Adam Berinsky noted.
This perspective reflected a respect for and consideration of the individuals, families, and communities directly affected by the research, evidence, and health policies discussed across three main themes: state innovation, progress on social determinants, and opportunities to enhance the use of evidence in policymaking.
One emerging theme over the course of the two-day conference was the idea that health happens at the local level. The conference highlighted the work of the states to improve the health of their communities through navigating the political divide, combatting the opioid epidemic, and innovating through the use of Medicaid waivers.
North Carolina’s Health and Human Services Secretary Mandy Cohen shared her experience in Tuesday’s lunch plenary in bringing together those with disparate political views around smart spending. “We’re asking, how are we using our dollars to buy health? Not health care, but health.”
In a breakout session on state innovations to address the opioid crisis, Carlos Blanco of the National Institute on Drug Abuse highlighted one particular key to innovation. “We have to have a dialogue back and forth between science and practice so that at the end of the day, we are not just publishing papers but we are advancing the health of the public,” he said.
Jeff Talbert of the University of Kentucky agreed, noting his university’s partnership with Kentucky’s state government through the AcademyHealth hosted State-University Partnership Learning Network. He credited some of the state’s progress to the embedded researchers within the state government, who found that very few prescribers were using the state’s prescription drug monitoring program – and those who were using it were only doing so about 10 percent of the time.
As the Centers for Medicare and Medicaid Services (CMS) have stepped up approval of state waivers and demonstration initiatives, there were several sessions focused on how various states are making the ACA work and the challenges still ahead.
Social Determinants of Health
A sobering quote from the final day one keynote on social determinants speaker Bob K. Ross, “80 percent of health outcome factors are outside clinical care,” reminded attendees of the importance of addressing the social determinants of health and including considerations of these factors in larger discussions on health and health policy. The theme of social determinants of health was woven through the conference, in comments by speakers acutely aware that there are a plethora of factors affecting health.
Sara Rosenbaum of the George Washington University School of Public Health connected an analysis of Medicaid work requirements to issues related to the inability of individuals to gain employment due to a lack of access to oral health care. Later, speakers from the Task Force on Low Value Care noted the importance of using language that can reach patients of every socioeconomic and health literacy background. Elizabeth Cope of Aequitas LLC, presenting on PCORnet as a tool to support evidence-based policymaking for population health improvement, highlighted PCORnet’s work to promote health equity through its collaborative research groups focused on health disparities, social determinants of health, and other related topic areas.
When asked how the health care system can work to alleviate inequality and systems that propagate institutional racism, plenary speaker Rishi Machanda of HealthBegins echoed Bob K. Ross. Ross urged to “harness the power of people for better health,” to which Machanda replied the answer is to invite community health workers, patients, and others from communities into the audience to give them a voice.
Evidence in Policymaking
While many throughout the conference expressed dismay at the lack of evidence in policy debates and decisions, Doug Holtz-Eakin of the American Action Forum opened Monday’s lunch plenary on this subject with a description of the enduring value of academic research in policy decisions, saying: “People will say whatever they can to get their policies enacted. Research is the only check on the policy process.”
The U.S. Surgeon General Jerome Adams also highlighted this theme in his remarks on Tuesday morning. As an example of how health affects many other policy areas such as national security, he noted that seven out of 10 young Americans are ineligible for military service for physical, criminal or educational reasons. This interconnection makes the role of evidence all the more important.
“We can't help folks understand how health is important to the issues they care about without the data,” Adams said.
Congressman and Democratic Whip Steny Hoyer (MD) agreed, emphasizing the important work of health policy researchers in these uncertain times.
“Your work has never been more consequential or critical,” he said to attendees.
And with those parting words we leave the conference feeling energized and ready to move evidence into action in 2018. Until next year!