Policy Roundtable Abstracts - AcademyHealth

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care services and financing, cost containment, and emerging policy issues. IMPACT These states vary by geography, political and policy environments, and health care markets, but the individuals are all leaders in driving health policy broadly and in thinking through the issues around developing an exchange. They represent different positions in state government. They have all agreed to participate on the panel, but given their key roles as policymakers, their availability is subject to change. Clearly, they are forging new ground, and through this panel they will provide valuable evidence and expertise on early lessons learned that will go far to assist all states and policymakers as they move forward with implementation of health reform. Identifying, Monitoring, and Evaluating Promising Payment and Delivery System Innovations Organizer/Moderator: Stuart Guterman Sunday, June 12 * 4:30 p.m.–6:00 p.m. Panelists: Marsha Gold, Sc.D.,M.P.H., Mathematica Policy Research; Lawrence PCasalino, M.D.,Ph.D., Weill Cornell Medical College; Randall Brown, Ph.D., Mathematica Policy Research, Inc.; Paul Wallace, M.D.; The Permanente Federation, LLC. Roundtable Summary: The national health reform legislation includes a multitude of new demonstrations and pilots to cut costs and increase quality in our health care system. As Atul Gawande notes in his recent article, “Testing, Testing”, health reform legislation “contains a test of almost every approach that leading healthcare experts have suggested” for improving health care financing and delivery. One of the principal reasons for why we have yet to implement the many ideas being proposed to reform the current delivery system is that we lack sufficient information on how the proposed organizational and financing reforms would work in practice. To address this knowledge gap, the Patient Protection and Affordable Care Act signed into law in March 2010 establishes Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS). This new center will facilitate the development of pilot projects and propose strategies to disseminate and promote the uptake of successful delivery system reforms. As Stuart Altman and Robert Mechanic note in a recent article in the New England Journal of Medicine, a key difference of demonstrations developed under the Innovation Center from previous Medicare-sponsored demonstrations is the Secretary of Health and Human Services’ new authority to expand pilot programs that successfully reduce costs or improve the quality of care. In a recent analysis of the prior challenges that have arisen when demonstration projects were used to inform policy, Stuart Guterman and Heather Drake of the Commonwealth Fund note that prior demonstration programs were hampered in their ability to move from testing innovations to their broader application in practice due to “limitations in the methodology and data available to conduct comprehensive evaluations of demonstrations projects” and “insufficient resources for developing, implementing, monitoring, and evaluating demonstration projects.” In this session, a panel of experts with a variety of perspectives will address the problems identified with moving from the pilot or demonstration phase to broader program implementation, including limitations in methods for assessing and evaluating promising interventions. This session will include a presentation by Marsha Gold of a paper she is preparing on this topic, and a panel discussion of the methodological issues related to identifying, monitoring, and evaluating promising payment and delivery system innovations, and the contribution that the health services research community can make to this process. The panel will assess and seek to identify solutions on the following five critical areas: 1) Criteria used to prioritize innovations that merit an investment in evaluation and scale up 2) Best practices in the design and implementation of the pilot intervention itself, 3) Best practices in the design of evaluations 4) Criteria for judging success 5) Strategies for scaling up successful pilots As Guterman and Drake conclude in their paper, the success of the Center will depend upon its ability “to develop reliable methods for monitoring and evaluating pilot projects and analyzing the applicability of various aspects of individual pilots for implementation in different combinations and settings.” Anticipating that policymakers will need clear direction for meeting the ambitious goals set for the new CMS Innovation Center, this project will seek to resolve the inherent conflict between making quick assessments of promising innovations and the need to provide compelling evidence that the project would improve quality and or reduce cost. Potential topics for the panel members to discuss include the following: What criteria should be considered in selecting an innovation that merits evaluation What do we need to keep in mind about the evaluation design and methods For example: Should evaluation criteria include both quality and cost measures o How is context considered in the o design How do we move beyond randomized trials to explore relationships of causality What constitutes success and when and how should pilots be scaled up How do we turn what gets learned from pilots into system-wide policy The panel moderator and leader of the discussion will be: Stuart Guterman, vice president for Payment and System Reform at The Commonwealth Fund and executive director of the Fund’s Commission on a High Performance Health System. The Commission on a High
Performance Health System is charged with promoting a high-performing health system that provides all Americans with affordable access to high-quality, safe care while maximizing efficiency in its delivery and administration. The Program on Payment and System Reform supports the analysis and development of payment policy options that include incentives to improve the effectiveness and efficiency of health care delivery while curbing growth in health spending. Previously, he directed the Centers for Medicare and Medicaid Services Office of Research, Development, and Information. The panelists will include: Marsha Gold, Ph.D., a senior fellow at Mathematica Policy Research in Washington, DC. She is a nationally known expert on health care delivery and financing, especially in managed care and public programs such as Medicare and Medicaid. Her expertise covers trends in the organization and financing of medical care and its implications for access to care. Lawrence Casalino, M.D., Ph.D., Chief of the Division of Outcomes and Effectiveness Research and The Livingston Farrand Associate Professor of Public Health in the Department of Public Health at Weill Cornell Medical College. His research focuses on the organization of physician and hospital practice. Randall Brown, Ph.D., an expert in health care policy issues related to care for the chronically ill, longterm care, managed care, and quality of care. He is nationally known for his evaluations of care coordination and disease management programs for Medicare beneficiaries, as well as studies of long-term care issues and Medicare managed care. Paul Wallace, M.D., medical director for Health and Productivity Management Programs at Permanente Federation and senior advisor for the Care Management Institute (CMI) and Avivia Health, the Kaiser Permanente disease management company established in 2005. Since 1997, his full-time focus has been administrative and development endeavors in the application of evidence-based medicine within disease management, measurement of clinical performance, technology assessment, and use of the electronic medical record. The Ongoing Politics of Health Reform Organizer/Moderator: Walter Zelman Monday, June 13 * 8:00 a.m.–9:30 a.m. Panelists: Walter Zelman, PhD, California State University, Los Angeles; Mollyanne Brodie, PhD, Kaiser Family Foundation; Len Nichols, PhD, George Mason University; Alan Weil, JD; National Academy for State Health Policy Roundtable Summary: I propose to offer a policy panel focused on the ongoing politics of health reform. The panel will explore the political elements of the ongoing debate over health reform and the efforts of some to repeal or alter it and others to defend it and move it forward. While reform has passed it is clear that the political struggle around it goes on, with a variety of efforts underway to undermine or repeal it. While few expect reform to be repealed in the near term, efforts at the state and national levels still threaten its implementation and conceivably, the election of 2012 could be, in large part, a referendum on reform. Specifically, the panel will look at such factors as public opinion, support and opposition of activities of various interest groups, positions of key political and partisan organizations, and messaging and other strategies being deployed by reform supporters and opponents. It will also review those health reform constructs that are engendering the most controversy and how the different stakeholder and political organizations are addressing those issues both in terms of content and message. The panel will focus on both federal and state government activities. At the federal level the panel will review political activity in both Congressional and regulatory arenas. The purpose here is not to explore the substantive proposals at issue. It is assumed that those will be thoroughly addressed by other ARM sessions. The purpose here is to look at the political side of the reform equation: interest group efforts, public mobilization, electoral considerations, media and messaging strategies, etc. Specific policy areas may be addressed, but primarily to the extent that they are being highlighted by reform opponents or supporters as part of the larger reform debate, and to the extent that those policy areas may still be open to a larger negotiation on reform policy. Looking ahead, the panel will discuss the role the ongoing health reform debate may assume in 2012 elections. Regarding health reform politics in the states, the panel will focus primarily on the efforts of the states to establish the health reform infrastructure necessary to implement reform. Most specifically the panel will review Exchange-focused discussions and activities in the different states. It will review how political leadership in the various states –especially governors and legislators—are approaching the exchange issue. E.g. are Republican governors taking the view that while they oppose reform and may fight it in court proceedings they are still going to support creating the exchange infrastructure should their efforts to roll back reform fail Or, are at least some taking the view that the process of creating (or failing to create exchanges) is part and parcel of the larger effort to undermine reform To this end, an effort will be made (data permitting) to compare the progress being made on the creation of exchanges in different political environments. As will be the case with a review of national government activities, the panel will look at the state level involvement of stakeholder groups, political leadership, and messaging strategies. Four individuals have agreed to participate in the panel discussion. (One more may be added) All have been deeply involved in the reform process in one way or another. All are unquestioned experts in the both the policy and politics of health reform. All have written extensively on the subject, as researchers and policy analysts. All are continuing that involvement and that research.
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Policy Roundtable Abstracts - AcademyHealth

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