The Annual Research Meeting continued with a productive day 2 of educational sessions in Boston. Check out session summaries below.

10th Anniversary of Medicare Part D: Lessons Learned and Future Directions

Chair: Cindy Parks Thomas; Discussant: William Shrank; Speakers: Sean Cavanaugh, Jack Hoadley, Bruce Stuart

During this session, panelists and speakers reflected on the impact the Medicare Part D program has had on beneficiary access to prescription drugs and the healthcare marketplace over the last ten years as well as the future of the program. The session began with an overview presentation of the last ten years of the Medicare Part D program by Jack Hoadley. Followed by Bruce Stuart, who presented on “Part D & Beneficiary Health: What We Know, What We Don’t Know, and Need to Know”. Speakers, Sean Cavanaugh and William Shrank then shared thoughts from the business/organization perspectives speaking on PBMs and pharmacies as well as discussing challenges moving forward and the future of the Medicare Part D program.

With only two formal presentations, questions arose early on in the session and proved for a lively discussion. Question/discussion topics included:

  • Does Part D make beneficiaries healthier?
  • Will increased drug adherence reduce Medicare costs for hospital care and physician services?
  • What about the elephant in the room—cost?

This session aligns with AcademyHealth’s pursuit of lower costs and high value from the health care system.

Late-Breaking Session: Improving Clinical Care

Chair: Alan Weil; Speakers: Yuhua Bao, Tianyan Hu, Krutika Jariwala, Kaile Ross,Thomas Wickizer

AcademyHealth’s special late-breaking abstract sessions highlight compelling research that surfaced after the original call for abstracts deadline; it is likely to have a significant impact on the research community or represent a major advance in the field. Presenters in this late-breaking session addressed the organization and delivery of care: the effects of managed care, the patient-centered medical home (PCMH), behavioral health integration on care processes and health outcomes, and the pressing public health concerns of lead poisoning and opioid abuse.

Among the findings presented, Dr. Bao’s work on the opioid epidemic revealed that mandates of prescribers’ participation in drug monitoring programs were associated with a 9-10 percent reduction in the prescriptions of and spending on Schedule II opioids by Medicaid patients; Ms. Ross’s work on taking an integrated approach to mental health, the costliest medical expenditure in the United States, improve behavioral health services in primary care and can reduce the overall cost of care; and Dr. Wickizer’s study found that Medicaid may be an effective program for expanding access to the PCMH model in low-income adult populations.

Each of these presentations exemplify why research continues to be important, particularly when it comes to patient care. As the professional society for health services research, AcademyHealth supports work to advance public and population health.

Emerging Issues in Readmissions

Chair: Steven Sheingold; Speakers: Lena Chen, Joel Ruhter, Rachael Zuckerman, Karen Joynt

Given the increased focus surrounding hospital (re)admissions, ASPE is monitoring changes in hospital readmissions across settings, which encompass the Medicare quality programs the Hospital Readmission Reduction Program, the SNF quality reporting program, and the home health agency quality reporting program. This session covered the implications of moving to a broader state of readmissions, the role of post-acute providers, an examination of where patients are discharged and why it matters (e.g., dual patients are less likely to be discharged to their homes and more likely to be discharged to SNF), and the place of skilled nursing facilities. There was also a discussion of the relationship between the performance of Medicare’s payment programs and socioeconomic status and how vulnerable populations tend to fare under readmission measures.

  • Dr. Sheingold noted at the beginning of the session how surprised he was that readmissions-focused work has expanded as much as it has, mostly from the United States, but also from people abroad.

AcademyHealth advocates year-round for the health services research that gives policymakers, providers, and the public insight into how the health care system is working and how we can improve. This session and the research presented within it is one such example of how we can better understand the state of the health care system.

Beyond Structure, Process, and Outcome: Reflections on 50 Years since the Donabedian Models

Chair: Donald Berwick; Speakers: Speakers: Maureen Bisognano, Helen Burstin, Carolyn Clancy, Lucian Leape

With a crowd of over 300, Monday’s session “Beyond Structure, Process, and Outcome: Reflections on 50 Years Since the Donabedian Models” honored the late Avedis Donabedian and the 50 year anniversary of his landmark article, “Evaluating the Quality of Medical Care.” The panel both clarified and celebrated Donabedian’s seminal contributions and explore the modern methods of quality definition, measurement, and improvement that today go far beyond the precepts of that giant in the history of health services research. The interactive session left plenty of time for attendees to ask questions about the impact of Donabedian’s paper, such as:

- What would Donabedian think about the support his ideas have gained within the HSR community?

- Is the industry moving towards measuring quality with a team mentality?

One of the largest sessions of the 2016 ARM, this panel was a representation of AcademyHealth’s commitment to improving the research data infrastructure.

Linking Clinical Claims and Population Data

Chair: Bobbie Kite; Speakers: Julia Adler-Milstein, Jennifer Gaudet Hefele, Amy Kinner, S. Raquel Ramos

In this call for papers session, four panelists presented innovative designs and methods toward connecting larger population efforts with vulnerable patient populations. The session began with a demonstration of linking clinical claims and population data to create rich sources of information, followed by an explanation of theorized cost savings from linking clinical claim and population data. The Q&A at the end of the session delved deeper into the following factors:

- The robust health information required for health system exchanges

- Finding reliable relationships between technology applications like Facebook

- The potential for e-consult to reach patients

This session signaled to the field the relevance and use of health services research to improve public health systems, population health, and health equity.

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