Dr. Simpson remarks
Dr. Lisa Simpson Opening Remarks NHPC 2018

For 18 years, the National Health Policy Conference has been the first conference to look at the health policy year ahead of us --considering the people, policies and politics that will drive the debate here in Washington, as well as the states --and the only one to dissect diverse issues from across health policy with a sharp focus on the evidence and expertise needed to make tough decisions.

Last year at this time, I asked, “Will evidence matter in 2017?” I was, as is my nature, optimistic. We knew then that 2017 would be a year of intense debate, over the Affordable Care Act and its future, the budget, and many other issues. But looking back, I am struck by the issues I did not see coming, and frankly, and perhaps naively, by the degree to which evidence, data and facts themselves would be the subject of debate.

We have seen unprecedented proposed reductions in research funding, attacks on science, questions about the role of the Congressional Budget Office and failures around the transparent collection of, and access to, public data. As an organization committed to research, AcademyHealth’s North Star is and always will be EVIDENCE. We hold strongly that production and use of high-quality evidence is essential, whether to make sure we understand the factors affecting individual and communities and their health and health care or to provide each and every stakeholder with the data, facts, and evidence they need to make better choices and inform sound policy.

So I remain committed to being an optimist and these days focus my energy looking for opportunities for progress in the year ahead, regardless – or sometimes in spite of – the issue “du jour”. The government is open today - but for how long we don’t know -, and CHIP has been reauthorized for six years. But much remains to be done. As this continuing resolution expires on the 8th and is replaced, perhaps with a deal to raise budget caps (we can only hope!) and the President’s request for FY2019 is made public, we’ll have a better idea of what the year to come may look like. And I should note that tomorrow we’ll hear directly from House Democratic Whip Steny Hoyer, who may be able to give us some insight on these points.

In the meantime, I encourage each one of you to find the areas where you see opportunity for progress in the year ahead. Personally, I see three areas – each of which is covered in our agenda over the next two days. They are innovations at the state level, progress on social determinants of health, and increasing use of evidence and data in policymaking.

Let’s start with the states. Wow are they busy these days! And not just because of the seemingly relentless toll of severe weather events. The Centers for Medicare and Medicaid Services (CMS) has stepped up its approval of state waivers and state plan amendments while also funding a range of demonstration initiatives. A number of states are measuring and incentivizing progress in reducing potentially preventable events.

Other states are focused on how to support their high-cost and high-need populations, as well as confronting the tragic impact on individual lives, families and communities of the opioid epidemic. State government and state university leaders are showing incredible creativity in combatting this growing epidemic and we will hear from some of their leaders.

States are also innovating in other areas from care coordination of patients with multiple chronic conditions to expanded access to care via academic medical centers – proving that states continue to be important laboratories to understand not only whether something worked, but why, and how to replicate effective policies elsewhere. AcademyHealth supports their work to test, evaluate and spread effective approaches through two partnerships: the Medicaid Medical Directors Network and the State University Partnership Learning Network.

The second area where I see opportunity for progress and that many speakers are addressing at this conference is a focus on Social Determinants of Health. The last year brought us stark reminders of the continuing divisions and deep wounds in our society, whether by race, gender and/or class, among others. The enduring and abhorrent impact of these and other forces on health and wellbeing is evident every day and this – more than anything – challenges anyone’s optimism, including mine. Yet progress can be found and we can all learn from, and be strengthened by, that progress.

Delivery systems across the country are determined to address the issues outside the clinic that have such a disproportionate effect on the health of some of their patients. Through the Accountable Health Communities model, CMS will screen over 3 million beneficiaries (both Medicare and Medicaid) to identify needs in housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety.

Meanwhile efforts in Massachusetts, Maryland, Washington and Minnesota are focused on advancing the use of evidence-based policies on another area of health inequity: adverse childhood experiences such as abuse and/or neglect.  And in New York, researchers are using big data to better understand the impact of non-health policies on health.

So that leads me to my third area for policy progress in 2018: the Use of Data and Evidence in Policymaking.

Actions often have unintended consequences so perhaps recent debates about “truth decay” and a “post-fact” world are waking the public up to the need for more, not less, use of data and evidence in policymaking. The bipartisan legislation introduced in Congress last year, based upon recommendations from the Commission on Evidence-Based Policymaking, paves the way for meaningful improvements in how we use data to inform policymaking. With the legislation’s focus on evaluation, it is clear there is an appetite for understanding what is working and what is not, creating an opportunity for us to put our increasingly well-tuned evaluation methods into practice for measureable impact.

There is also a focus on facilitating data access for evidence building, a key component to enable new, creative solutions in health care. Not a week goes by without another news story about how data and technology will transform health care. Whether it is Apple working to put all our medical records in our smartphones or Google using artificial intelligence to predict patient mortality or  Amazon, JP Morgan and Warren Buffett launching a healthcare company for their estimated 1 million employees – these are exhilarating and disruptive times. What exactly these innovations mean for healthcare and individual decision-making remains to be seen, but they are all exciting developments in the ongoing move to improve healthcare, empower and engage individuals in their care, and reduce healthcare costs.

So as you go into each session, bring your most inquisitive and analytic minds – let’s tease apart together what is hype, what is real, where progress has been or can be made and what areas we are still stumbling in. Challenge yourself and each other – respectfully of course – to inform and elevate the debate, to move us beyond partisan rancor and tropes to real solutions.

And always, always value and use the key ingredients: evidence, data and facts. Remember the dictum: “All improvement is change, but not all change is improvement.” Our challenge in health policy is being able to tease out when – and for whom – changes are improvements. For those of us who produce evidence and use it to improve health and health care, there is no time to rest. We have much left to do, and plenty to discuss. I look forward to digging into these issues and more with you and our expert presenters over the next two days.

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