The 2015 AcademyHealth Annual Research Meeting got off to a strong start Sunday, as some of the brightest minds in health services research flocked to the Minneapolis Convention Center to discuss the latest, most cutting-edge work in the field. With sessions covering everything from the milestone anniversary of Medicaid to the Supreme Court's impending decision on King v. Burwell to the '$2 trillion question' of whether the slowdown in health care cost growth will continue as well as 18 tracks that covered themes including behavioral health, complex chronic conditions, health information technology, and maternal and child health, there was something for everyone.
With the takeaways from the day's sessions--recapped below by AcademyHealth staff--we're optimistic that the 2015 meeting will continue with the same energized, upward momentum:
Making Sense of Evaluation Data for Policy: Meta-Analysis and a Data Visualization Dashboard
During this first session of the Innovation Station, speakers Anupa Bir, Robert Chew, and Kevin Smith of RTI International and Timothy Day of the Centers for Medicare and Medicaid Innovation demonstrated a data visualization tool—an interactive dashboard—designed to analyze the 108 projects within the Health Care Innovation Awards. Through their presentation, panelists revealed how the dashboard allows researchers to manipulate variables and characteristics of interest (e.g., projects on health information technology), and help both program managers and policymakers alike understand project relationships and patterns without doing programming and analysis. Ultimately, tools such as this one could help facilitate the translation of research into policy and practice.
Evidence-Driven Innovation in Minnesota
This morning’s session, Evidence-Driven Innovation in Minnesota, moderated by AcademyHealth’s Enrique Martinez-Vidal, brought together local experts to discuss the evidence-based innovations in the state.
Katie Burns of MNsure began by highlighting how the 2008 Minnesota health reform law helped the state more effectively create the Minnesota state exchange. She noted the successes and challenges the state faces, such as consumer outreach and support. Brokers and navigators, for example, are important partners with the state in reaching the uninsured eligible to purchase private coverage or utilize coverage, and plan comparison tools are vital in consumer support. However, given the high rate of insured in the state, the remaining uninsured population will be more expensive and harder to reach.
Echoing Katie Burns, Healther Petermann of the Minnesota Department of Human Services, pointed to the unique innovations and evidence in the state, which have also led to both challenges and opportunities in implementation. Petermann discussed Minnesota accountable care organizations (ACOs), particularly Integrated Health Partnerships and the important role of flexibility, which allows for local responsiveness and innovations, as a key factor in their success.
Offering a public health perspective, Daniel Pollock of the Minnesota Department of Health, emphasized the importance and success of locally-driven interventions and programs, such as Minnesota’s Statewide Health Improvement Program (SHIP), which takes place in schools, businesses, and communities. Notable SHIP successes include those in Duluth for tobacco control, Fergus Falls for fresh foods, Madelia for non-sugary drinks, Mankato for small business initiatives, Olmsted County for affordable housing units and a smoke-free housing community, and tribal areas for a farmers market to provide healthy eating options and economic growth. When programs are locally-driven, the community decides, determines, and is invested in their success.
Lastly, Jennifer Lundblad of Stratis Health presented Stratis' contributions to the growing body of health care reform evidence: improving care transitions and reducing unnecessary readmissions, which built on an existing body of evidence and contributed new perspectives; using health information technology to improve quality and safety as well as empirical data to ultimately improve policy and programs; and building rural palliative care capacity, which resulted in a new model and a base of evidence where there was none before.
Minnesota’s long history of health care reforms and efforts in the state continue to provide insight on how those ‘on the ground’ can continue to improve and advance ACA implementation.
Late Breaking Session: 2015 Coverage and Marketplace
This year’s Late-Breaking Abstract Series kicked off with a discussion on the current standing of coverage and the marketplace. Moderator Sharon Long, of the Urban Institute, kicked off the panel and noted the consistencies in research and findings across the board about gains in insurance coverage in the post-ACA era. The research, still in its primary phases, all highlighted the significant early gains under the Affordable Care Act, particularly in coverage, while also highlighting the continuing challenges of reaching the remaining uninsured.
Papers, panelists, and findings included:
- The Impact of Robust Health Insurance Marketplaces: Measurement, Correlations, and State-Level Policy Implications
- Examining Racial/Ethnic Disparities in Insurance and Access to Care Under the ACA
- Changes in Health Insurance Coverage and Access through March 2015
- Medicaid Expansion Versus the Private Option: Changes in Coverage and Access after the First Year
Abigail Barker
Washington University, St. Louis
Stacy McMorrow
Urban Institute
Adele Shartzer
Urban Institute
Benjamin Sommers
Harvard University
Abstracts and research will be published later this summer. The authors presented preliminary data, not yet available for release.
Luncheon Plenary - The Hidden Brain: Unconscious Bias and the Challenge of Change in Healthcare
Shankar Vendantam of NPR energized the audience Sunday with his plenary presentation on the challenge of change. Vendantam explored how the "hidden brain," his term for the range of forces that affect people without their conscious awareness, triggers a resistance to change and impacts the ability to innovate in health care.
"Our fundamental challenge," he said, "is how we spread what it is we know to the people who need it. It's a challenge of change, not a challenge of discovery."
Vendantam also explored psychological and communication strategies that can be useful in overcoming obstacles, particularly the idea of making the messenger the target. When people preach your message, those messengers are more likely to live in the image of that message, and will thus be a voice to create change.
Learning Across Health Care Systems: Comparing American and Canadian Performance
The world is smaller today than it once was, Romana Hasnain-Wynia told attendees. Thanks to the Internet, access to information, and a greater ease with which people can travel, country boundaries are blurring. Therefore, there is a call to action to advance the work of cross-national comparisons and an opportunity to bring research together to produce this comprehensive field of inquiry.
In this session panelists used the Commonwealth Fund report Mirror, Mirror to discuss equity and access in both Canada and the United States. Eric Schneider of the Commonwealth Fund began the session by reviewing some numbers from the report. In terms of timeliness, people in the United States report the ability to see a doctor in the same/next day, with Canada's number being slightly lower. People in Canada report longer waiting times in the emergency room or before being able to see a specialist. With regard to disparities, the variance runs between 6 and 10 percentage points between low and high income in Canada and between 9 and 22 percentage points in the United States. Quality of care is a mixed pictured; countries fall somewhere in the middle, but in overall ranking/healthier lives, the United States and Canada are "partners in crime," and don't fare well.
Jeannie Haggerty, McGill University, followed, explaining the differences in U.S. and Canadian health systems in the context of values: Canadians’ values tend to shift toward collective responsibility and "peace, order, and good government," whereas Americans’ values align with individual responsibility and "life, liberty, and happiness."
That collective responsibility affected the development of Canada's universal health system, where people revere the five principles "enshrined" within the Canada Health Act: universality, accessibility, comprehensiveness, portability, and public administration. In Haggerty's view, where the United States has an edge is that in Canada there is little capacity to influence what the physician workforce is doing; there are no competitors for better services like in United States; and there is a single payer, but non-integrated systems, which affects systems-level change. Most medical professionals in Canada are private, whereas the United States systems can implement a decision made at the top and trickle that change down the line. As mentioned during the Q&A portion, the United States was designed around productivity with fee-for-service but not much accountability for quality, yet what keeps the United States moving up is a greater sensitivity in the physician and care communities to the patient experience.
As countries move forward as a society, cross-country comparisons offer the opportunity to explore various options in health care and apply them to policy and practice in light of comparative evidence, to allow countries to learn from each other, and to facilitate a friendly competition between countries.
King v. Burwell, What’s Next?
Sara Rosenbaum from George Washington University’s School of Public Health moderated a very full panel discussion, which examined King v. Burwell and its considerable implications for the future of the Affordable Care Act.
Marybeth Musumeci of the Kaiser Family Foundation began the discussion with a brief overview and history of the federal case, which challenges the granting of tax subsidies to use in federal and state marketplaces, which in turn endangers insurance coverage and affordability for over 6 million Americans. Next, Nicholas Bagley from the University of Michigan outlined the possible outcomes of the decision that included scenarios of both the government and plaintiffs winning the case, based on analyses of the ambiguity of the law’s text. The discussion continued with comments from David Jones about the future of health exchanges and the state of play for states if the court rules in favor of the plaintiffs as opposed to states. He commented that most states do not have a plan of action if exchanges are shut down due to the lack of direction and comments from both the administration and Republicans, among other factors.
This panel began with the presentation of the Outstanding Dissertation Award to panelist David Jones of Boston University. The Outstanding Dissertation Award honors an outstanding scientific contribution from a doctoral thesis in health services research or health policy.
The $2 Trillion Question: Will the Slowdown in Health Care Cost Growth Continue?
This session, moderated by Stuart Guterman of The Commonwealth Fund, examined past and current trends in health care spending and offered insight into the future. All speakers agreed that we have been asking the wrong questions about health care spending.
Melinda Buntin addressed the Congressional Budget Office's estimates of future cost growth and their influencers. She focused the question on cost slowdown in terms of Medicare spending due to its implication on budgets. Summarizing the slowdown in Medicare spending, she noted that growth is pervasive across beneficiary types, service types, and regions.
David Stevenson focused on post-acute care (PAC) and hospice in Medicare, citing both as areas that have impacted the slowdown, yet offer an opportunity to gain efficiencies in the health care system. An unexplained portion of the slowdown is not due to one single factor, he emphasized, but PAC plays a large role. Stevenson concluded with changes that will impact PAC and hospice that could reduce variation and spending growth, including the expansion of ACOs, hospice payment reform and quality reporting, the Impact Act of 2014, and bundled payments for care initiatives.
Michael Chernew noted that the '$2 trillion question' is not the right question because it implies that spending growth is fate. His presentation examined the drivers of growth in spending on the commercially insured from 2001-2007 by episode. Instead of asking the $2 trillion question and analyzing spending by sector, he argued that we need to focus on clinical factors. Future trends will depend on technology, innovation, medical progress, and controlling medical spending growth.
