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.

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Another successful and energizing Annual Research Meeting is well underway. AcademyHealth staff are covering sessions throughout the conference. Also, stay tuned for thematic blog posts on a series of themes that will emerge throughout the conference. This blog series will be posted after the conclusion of the ARM.

End of Journals?
Chair: Erin Holve; Speakers: Ruth Carlos, Aaron Carroll, Hal Luft

Following this year’s first-ever opening plenary, the session “End of Journals?” focused on the recent push for open science to facilitate faster conduct and dissemination of research has raised questions about the future role of peer-reviewed journals. Chair Erin Holve and the session panelists debated how journals, open data resources, and other media can work together to disseminate evidence, engage end-users of the work, and promote collaboration to spur new discoveries. Panelists discussed the role of journals in health services research, the cost of journals, and the leadership behind publishing.

Questions raised by session attendees included:

  • How much should we promote open science?
  • How should researchers express the need for a peer-review process?

This conversation is central to AcademyHealth’s dedication to move knowledge into action through synthesis, translation, dissemination, and technical assistance.

Massachusetts Health Reform 10 Years Later
Chair: John McDonough; Speakers: Stuart Altman, Sharon Long, Audrey Shelto

The session “Massachusetts Health Reform 10 Years Later” was moderated by this year’s ARM Planning Committee Chair John McDonough. The session discussed the ways in which Massachusetts health reform provided the conceptual model for the Affordable Care Act and shared lessons learned from Massachusetts health reform ten years later. Speaker Sharon Long discussed health reform for nonelderly adults; Audrey Shelto spoke about similarities and differences between health reform in Massachusetts and in the United States and needed attention on health care affordability; and Stuart Altman highlighted Massachusetts concern with total health care spending, encompassing Medicaid, Medicare, and private insurance.

The panel left plenty of time for audience questions:

  • What should states aiming to build a health system similar to Massachusetts pay attention to?
  • How can we continue to pay attention to both health care coverage and health care access?

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

Effect of Financial Incentives on Physicians, Patients, or Both on Lipid Levels
Chair: Tim Doran; Speakers: David Asch, Kevin Volpp, Martin Roland, Andrew Ryan

One of the day’s last sessions, “Article of The Year: Effect of Financial Incentives on Physicians, Patients, or Both on Lipid Levels,” analyzed and debated the winning paper of the 2016 Article-of-the-Year Award, which found that shared incentives resulted in greater adherence to treatment and also led to modest but statistically significant reductions in cholesterol levels compared to controls, whereas incentives offered to physicians or patients alone did not. Co-authors David Asch and Kevin Volpp presented the findings of their randomized clinical trial of the effect of financial incentives offered to primary care physicians, patients, or both on reducing levels of LDL cholesterol in patients with high cardiovascular risk.

The session was a packed house, and session attendees raised the following questions:

  • Is depression playing a role in terms of engagement of a patient taking ownership of their health?
  • Is it possible that physicians and patients interacted together in this study?

This year’s Article of the Year session and study represent AcademyHealth’s belief that policies affecting health and the performance of the health system should be informed by the best and most relevant evidence.

Direct Observation Methods for Dissemination and Implementation Research
Megan McCullough, Bo Kim, Gemmae Fix

During this Innovation Station-hosted workshop, Drs. McCullough, Kim, and Fix took a didactic approach with attendees to explore direct observation, a qualitative and quantitative method used in health services research and implementation science that can provide direct insight for researchers into the environment being studied. Its benefits include capturing routinized, unconscious behavior; providing (work/life) context of staff or a medical center; and documenting a process, behavior, or interaction. Using a clip of documentary “The Waiting Room” as a simulation of real life, McCullough, Kim, and Fix allowed participants the opportunity to experience observation for themselves.

  • Rather than employing standard Q&A, speakers convened teams to discuss the video, including raising which elements stood out and determining the research questions that could be asked (and answered) based on what all was featured in the video.

AcademyHealth always strives to be responsive to the evolving methods needed to inform evidence. Direct observation is among the many methods, both quantitative and qualitative, that researchers can use to inform evidence-based policy.

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In four separate posts, Austin Frakt and Aaron Carroll from The Incidental Economist will describe their translation and dissemination process, specifically how they turn academic papers into interesting blog posts. Each of their posts will cover one of these questions:

  1. How do we read research papers?
  2. How do we decide what to write about?
  3. How do we make our posts interesting?
  4. How do we decide where to publish them?

This is the second post:

How do we decide what papers/topics to write about?

Aaron: Let’s start with the things I don’t like to write about. I will not cover presentations at meetings. Such research is often preliminary and has not yet been fully peer-reviewed. Much research presented at meetings never gets published. We shouldn’t react to it before then. I will not cover most basic science work, because I’m interested mostly in things that apply to humans at large, and that research — by definition — hasn’t gotten there yet.

I am most interested in new research that will apply to large populations or common issues. I’m especially interested in research that might be useful in policy discussions. I’m also interested in analyses from think tanks that fall under this definition.

My interests change over time. Right now, I’m super fascinated by nutrition. I’m also interested in things that focus on kids. I’m interested in measures of quality, screening, and population health. That list expands all the time.

I think I’m different from Austin in that I love to write about research that I think is really newsy. If I see a new study that interest me, I want to post on it immediately. I like to do that for the same reason I don’t necessarily talk to authors before I write about their work. I want to present my thoughts and my thinking, and I’d like for that to be as unfiltered as possible. Once many others have written on a subject, it’s hard for me to get back behind the veil of ignorance.

I also find that people who send me stuff get their research covered by me more often than they’d think. Not all the time, but I encourage people to have a low bar to send me their work!

Austin: I write about health policy-relevant research. Though there are rare exceptions, I don’t write about the latest government report or analyze proposed health care legislation.

So, what papers do I write about? This is pretty simple: Those I find interesting. My problem — and it’s a good problem — is I find more papers interesting than I have time to read, let alone write about. I have to let a lot of things go, or flag them for later. Sometimes later never comes. My backlog of writing subjects just keeps growing.

There’s one exception: if the paper I find interesting is also very hot, I may not bother writing about it. Everyone else will, and I let them go first. (I pass a lot of things to Aaron and, to my delight, he writes about them … so I don’t have to!) Only if I feel I have something unique and important to add will I consider weighing in. The world doesn’t need another voice echoing countless others.

It’s (typically) not interesting to me is to make the same arguments and points repeatedly. I always strive to write about something new. I don’t always succeed. Sometimes in an area I’ve already written about, a new, important paper is published, and I’ll consider writing about it. There are some topics I feel I own — hospital cost shifting is one example, reference pricing by CalPERS is another — and I have an almost complete history of work on them captured by my prior posts. It would pain me not to keep that going, so I do. I’ll write about every hospital cost shifting or CalPERS reference pricing paper.

Most of the work of writing is not finding what to write about, but finding a way to do so that’s interesting to others. I don’t always care that my writing on TIE be interesting to others — it’s my blog and I’ll do what I want. But for AcademyHealth, JAMA Forum, Upshot, and anywhere else paying me to write, I certainly do, as do those outlets’ editors!

How we make our writing interesting is the next topic of this series.

Aaron E. Carroll, MD (@aaronecarroll), is a professor of pediatrics at Indiana University School of Medicine. Austin B. Frakt, PhD (@afrakt), is a health economist with the Department of Veterans Affairs, an Associate Professor at Boston University’s School of Medicine and School of Public Health, and a Visiting Associate Professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. Both blog about health economics and policy at The Incidental EconomistThe views expressed in this post are those of the authors and do not necessarily reflect the position of the Department of Veterans Affairs, Boston University, Harvard University, or Indiana University.

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This piece aims to provide some insight into the new U.S. Preventive Services Task Force colorectal cancer screening guidelines and what they mean for health and health care.

What’s Happened? Earlier this week, the U.S. Preventive Services Task Force (USPSTF) released updated recommendations regarding screening for colorectal cancer.

The USPSTF…Who? The U.S. Preventive Services Task Force is an independent, voluntary panel of national experts from medicine and primary care who are focused on prevention and evidence-based medicine. The Task Force has existed for more than three decades. It has been convened and supported by the Agency for Healthcare Research and Quality (AHRQ) since 1998 and continues to make evidence-based recommendations about clinical preventive services and medications.

Why Are These New Recommendations Important? They present convincing evidence that screening for colon cancer reduces cancer mortality.

To put these recommendations into context, colorectal cancer is currently the second leading cause of cancer-related deaths in the United States; roughly 49,000 people are expected to die from it this year alone.

By studying evidence on the effectiveness of the various screening techniques (which include colonoscopies, multi-targeted stool DNA tests, and fecal immunochemical tests, among others), as well as their potential harms, members of the USPSTF found that “screening for colorectal cancer with several different methods can accurately detect early-stage colorectal cancer and adenomatous polyps,” therein allowing for early-stage treatment of patients.

When Should We Be Screened? When you turn 50.

The USPSTF recommends that screening for colorectal cancer begin at 50 years of age and continue until 75 years – and there’s a reason for using this specific age range.

According to USPSTF, the harms for screening during this age span is small and the benefits are “substantial.” The advantages of early detection of and intervention for colorectal cancer begins to decline after the age of 75; there is—at best—a moderate benefit to continue screening through the age of 85.

It’s also worth noting that Medicare already provides colon cancer screening without cost-sharing for Medicare beneficiaries, and therefore wouldn’t change with the new Task Force recommendation.

How Do These Guidelines Impact the Health and Health Care of Patients? They could save lives and money, for a start.

Despite the fact that colorectal cancer is among the leading causes of cancer-related deaths, around one-third of eligible individuals in the United States have never been screened for colorectal cancer.

USPSTF’s evidence shows that beginning screening for colorectal cancer at age 50 and continuing until 75 could markedly reduce the number of deaths resulting from colorectal cancer. At present, this effective preventive intervention is severely underutilized. It’s uptake by members of the American public could influence the tackling of colorectal cancer nationwide, proving itself a benefit in terms of lives and dollars saved.

Where Can I Learn More? The For The Media page on The JAMA Network, which contains a summary, a link to the full report (doi: 10.1001/jama.2016.5989, linked here), a video, and more, is a good place to start. The press release can be found here.

For a first-person perspective on the recommendations, read Michael Cannon’s “Ascertaining Costs and Benefits of Colonoscopy More Difficult Than the Procedure Itself” on JAMA Internal Medicine.

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By: Clare Roche, AcademyHealth

The Annual Research Meeting (ARM), deemed the premier health services research conference, brings together stakeholders leading the charge to transform the field. To uphold this prestigious title requires dedicated, collaborative efforts from the conference planning committee. Steering this year’s group of innovators was Boston native, Dr. John McDonough. Embracing his city’s landscape – a natural health care hub – Dr. McDonough and team carefully shaped the agenda for the 2016 ARM.

I was able to speak with Dr. McDonough about his experience as the conference chair, what he’s most excited about during the conference, and even some Red Sox baseball.
What has been the best part of planning this year’s Annual Research Meeting?

The best part of the Conference planning is being able to interact with so many AcademyHealth members who take time from their busy research and policy lives to construct the Annual Research Meeting conference agenda. These folks are incredibly busy and yet make the time to ensure that the conference will be compelling and timely, while upholding the strongest possible research standards.

Do you have a session(s) you’re most excited about?

I am particularly enamored by the Massachusetts Health Reform: 10 Years Later session. This law provided the conceptual platform on which the private health insurance expansions of the Affordable Care Act were based. We have put together a sterling collection of health policy experts on Massachusetts who will focus on the totality of the vast body of research that has accumulated since the law’s passage in 2006. Sharon Long has been the go-to person for the best data and analysis on the coverage impacts since before the law was even passed. Audrey Shelto leads the Blue Cross and Blue Shield of Massachusetts Foundation which has been the essential information source on the law and a prime mover in its passage and successful implementation. Stuart Altman is a national treasure, a deeply involved and respected health policy leader in Massachusetts — he will consider the impact of the law on cost containment in a state where much has been happening. This session is a guaranteed hit! 

Detailed agenda information is available here

In comparison, this year’s ARM registration numbers are much higher than those in years past. Is there anything in particular that you’d contribute this success to?

I believe Boston is part of the improvement. This city is an exciting place to visit and spend time in – so it’s attractive for families. Boston always attracts a wide and compelling audience of participants. Also, I think AcademyHealth just keeps getting better and better on all cylinders, programmatic, logistical, and marketing. The U.S. health services community is like no other on the planet and AcademyHealth is the go-to place for health services professionals to connect and to interact. Finally, the Affordable Care Act is the gift that just keeps on giving. The urgency and importance it has bestowed on the health services research and policy just never seems to abate, even in a presidential election year.

How do you think Boston has shaped this year’s agenda?

This town is legendary for politics, especially in a presidential election year. Our new (since 2015) Governor Charlie Baker, is a bonafide moderate Republican and is the most popular governor in the nation in a state as deep-dyed blue as you can get. Some of the intensity and excitement of this year’s political environment will rub off because so much is still at stake regarding the future of U.S. health reform and the ACA. Also, Boston has one of the deepest benches of health policy experts in any state in the nation – and many of them have been helpful in advancing ideas and suggestions to make the ARM compelling and successful. And, fingers crossed, last I checked the Red Sox are on or near the top of the AL East. So come on down.

With the assistance of this year’s planning committee, Dr. McDonough has formulated one of the best conference agendas to date. AcademyHealth is contributing record-breaking registration numbers to the well thought out program content and Boston as the 2016 host site. The Annual Research Meeting is set to take place Sunday, June 26 through Tuesday, June 28. If you haven’t secured your seat yet, register now here.

The full list of 2016 Planning Committee participants is available here.


 

John E. McDonough, DrPH, MPA is Professor of Public Health Practice in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health and Director of the HSPH Center for Executive and Continuing Professional Education. In 2010, he was the Joan H. Tisch Distinguished Fellow in Public Health at Hunter College in New York City. Between 2008 and 2010, he served as a Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pensions where he worked on the development and passage of the Affordable Care Act. For his full bio, click here.

Clare Roche is the Student Membership and Chapter Coordinator at AcademyHealth where she manages all student chapters and student members, as well as coordinates the scholarships and awards programs. She encourages you to get involved with AcademyHealth through the formation of student chapters which enhance the learning and professional development experience for students in health services research and health policy. Clare graduated from the George Washington University as a double major in Communication and Business. Contact her at [email protected].

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In four separate posts, Austin Frakt and Aaron Carroll from The Incidental Economist will describe their translation and dissemination process, specifically how they turn academic papers into interesting blog posts. Each of their posts will cover one of these questions:

  1. How do we read research papers?
  2. How do we decide what to write about?
  3. How do we make our posts interesting?
  4. How do we decide where to publish them?

This is the first post:

How do we read research papers?

Austin: My first point of (potential) entry is a paper’s title and authors. By email, I receive tables of contents of every journal I’m aware of that focuses on U.S. health care policy, health services research, or health economics, as well as those from some of the top medical journals. I lack the time to read even just the abstract of every paper in those dozens of tables of contents. But, I can, and do, look at every title and list of authors.

If a title looks interesting to me or the author list includes one of my favorite authors, I’ll look at the abstract online. My rough guess is that I look at the abstract of 10% of the papers that cross my inbox. Of those, perhaps one-third or so seem interesting or sound enough for me to want to read more. So, perhaps I read some of the text of about 3% of papers in the tables of contents I receive. That’s a rough estimate, but it’s probably not far off.

When I read a paper, it’s always in PDF Expert on my iPad. That way I can read it anywhere and mark it up.

If I’m considering showcasing a paper in a post, I’ll read the PDF of whole thing. I do this in the most boring way possible — top to bottom/front to back, linearly, annotating important passages, questions, and references to other papers I want to read. (If I’m not showcasing paper, but need to find just some bit of info, I read more selectively, just to find what I need.)

If the methods of a paper are very complex (e.g., some health economics papers), often I only get the gist of them. When I do that, I find a colleague with greater methodological expertise to vet the methods. I do not rely on the journal review process to have served this role. Nor do I trust that a paper’s discussion of limitations to reveal all the important ones. I’m a very skeptical guy.

With high frequency, but not always, I send authors questions. Sometimes I wonder if they’ve done the analysis another way. Often they have, and they share the results. Sometimes I just don’t understand something, and they clear it up. Sometimes I find errors, which they confirm.

I guess, to me, a paper is often just the starting point of a dialog with authors and colleagues.

Aaron: I’m so glad we’re doing this. I’m fascinated by your response. I never, ever look at the authors. I look at tons of tables of contents as well, but only for the titles. If something piques my interest, I’ll go further.

My next step is to look at the abstract, trying to answer some specific questions at each point. I hit the objective — is this a hypothesis that interests me? I look at the methods — are they appropriate to test the hypothesis? I look at the results — what did the methods reveal? I tend not to spend too much time on the background or conclusions.

If I’m still interested, I will now pull the paper and read the methods critically. I’m already trying to poke holes in the work. Where are its flaws? What are the limitations?

Next, I jump to tables and figures. Table 1 usually tells me if this was an appropriate population for study. It also tells me how generalizable the findings may be. Then, I look at the other tables and figures, which should tell me about the key findings of the paper. Finally, I will read the results to make sure I didn’t miss anything.

I do read conclusions, but less to see what the authors felt about the results than to see what they thought the limitations were. Do they agree with me? Did they see things I didn’t? Did they miss something I picked up?

I rarely contact the authors of a paper, unless I have a specific question. I like to think that studies should stand on their own. If I can’t figure something out, though, I do reach out. I set a deadline on that, though, and will update after posting if I hear back.

One thing I never do, though, is read press releases. I make it a point not to discuss papers I haven’t read myself.

But we’ve skipped a step: There are more good papers out there than we have time to write about. How do we decide which to give attention? We’ll address that in our next post in this series.

Austin B. Frakt, PhD (@afrakt), is a health economist with the Department of Veterans Affairs, an Associate Professor at Boston University’s School of Medicine and School of Public Health, and a Visiting Associate Professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. Aaron E. Carroll, MD (@aaronecarroll), is a professor of pediatrics at Indiana University School of Medicine. Both blog about health economics and policy at The Incidental EconomistThe views expressed in this post are those of the authors and do not necessarily reflect the position of the Department of Veterans Affairs, Boston University, Harvard University, or Indiana University.

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By Megan Collado, AcademyHealth

Health care policy wonks and stakeholders have anxiously awaited the proposed rule from the Centers for Medicare and Medicaid Services (CMS) on the value-based payment programs under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Its release on April 27 lays out key parameters for a new Medicare physician payment system aimed at rewarding quality of care rather than quantity and asks experts to share their feedback to inform implementation.

Months prior to the CMS release, AcademyHealth hosted an invitational meeting on the subject of paying for value as part of the Research Insights Project to foster discussion on research evidence among policy audiences who need it to implement health reform. Here are three challenges discussed at the meeting and how the field is working to address them:

Accounting for risk

When faced with sub-par performance evaluations, many physicians respond with: “But my patients are sicker.” Most existing risk adjustment systems fall short of fully explaining patient health status and the likelihood of success for any course of treatment.

An innovative approach to risk adjustment showed promise in a small-practice program in New York in 2009-2010. The Primary Care Information Project (PCIP) furnished electronic health record systems to support a tightly-targeted pay–for-performance intervention. The PCIP adjusted payments upward for patients who were considered more difficult to treat successfully based on a few key indicators: whether they had comorbid conditions and whether they were uninsured or on Medicaid. Results were better in participating clinics than in a control group and also compared favorably with larger practices with similar goals.

Big data can also be a useful tool in identifying patients at risk. Beth Israel Deaconess Medical Center (BIDMC) has worked to use clinical and demographic patient data in an intensive care unit (ICU) safety initiative. After heightening focus on preventable harms, the 650-bed BIDMC has reduced the number of harm events in its ICU from as high as 90 in the second half of 2008 to fewer than 25 per six-month period throughout 2013 and 2014.

Evaluating quality

In a patient-centered era, patient experience has become one of the key measures of quality. But the cost and administrative burden of administering surveys, which often have a low response rate, have led providers to look for additional means of measuring patient experience, such as open-ended narratives.

Physicians often find that written comments from patients are some of the most useful and meaningful forms of patient feedback. The popularity of open-ended formats, such as Yelp and Angie’s List, point to the appeal of narrative evaluations for consumers. Researchers have recently used natural language processing to analyze Yelp reviews of 1,352 hospitals by 17,000 consumers and found that the information may provide a useful complement to surveys such as the Consumer Assessment of Healthcare Providers and Systems.

Determining value

While there are numerous challenges to measuring clinical quality, quality is only one component of health care value. Many questions remain about how best to define value and to measure it.

The Alternative Quality Contract (AQC) is an acknowledged leader in the efforts to effectively integrate cost and quality. Massachusetts’ Blue Cross Blue Shield plan operates the AQC in which contracting providers receive a risk-adjusted global payment for all their attributed enrollees. The payment covers all services and the provider organization is at risk for its contracted share of losses as well as gains. Spending growth rates were reduced by 50 percent in the program’s first four years, showing that provider behavior can be changed with a combination of strong incentives: putting providers at risk for high costs and offering generous rewards for measured quality.

The complexity of the value-based measurement universe goes far beyond these three challenges. Many more issues were discussed at the December Research Insights meeting. For more, read the full Paying for Value issue brief here.

colladom_headshot(1)Megan Collado, M.P.H., is a senior manager at AcademyHealth, where she co-directs and supports a number of Robert Wood Johnson Foundation grantmaking programs and is the Project Director of an AHRQ-sponsored conference grant that convenes policy audiences to discuss the evidence and future research needs related to health care costs, financing, organization and markets. 

 

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Late last year, I got a call from Steven Pearson, the president of ICER, the Institute for Clinical and Economic Review. He wanted to know if I would consent to being a member of the new Midwest CEPAC (Comparative Effectiveness Public Advisory Council):

The Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), a core program of the Institute for Clinical and Economic Review (ICER), is a nationally-recognized community forum. The Midwest CEPAC convenes three times each year at public meetings to review objective evidence reports and develop recommendations for how stakeholders can apply evidence to improve the quality and value of health care.

Midwest CEPAC directly engages clinicians, patients, and payers during public meetings to discuss implications of the evidence for clinical decision-making and coverage policies. Application of evidence takes shape through new medical policies, benefit designs, and patient and clinician tools to improve clinical care and patient outcomes.

My initial impulse was to decline. I have so much on my plate these days that I find there’s little time to engage in new endeavors. But Austin is a fan of ICER (he serves on the New England CEPAC), and when I listened to Pearson, it because clear that this was something I would otherwise fight for. I’ve written many times about how we need to be able to talk about cost-effectiveness in the public sphere. This was my chance.

I know that ICER gets a lot of press, much of it negative. I also think that press is misguided.

We recently had our inaugural meeting. Its purpose was to discuss “Treatment Options for Relapsed of Refractory Multiple Myeloma: Effectiveness and Value”. This isn’t my usual area of clinical expertise, so I immersed myself in the expert report, as well as the relevant literature. Both are publicly available, and very well done.

The meeting, which was also public, was attended by far more people than I would have expected. The first few talks detailed  the relevant research, as well as a very impressive cost-effectiveness model (all of which you can review here). Questions were permitted, and everyone was attentive and listening carefully. Then, we heard from members of the public who had pre-registered to deliver oral remarks. Most people were from advocacy organizations, and did not seem to like the fact that we were discussing value in this setting. This was followed by comments from various representatives from manufacturers (drug companies). They didn’t seem inclined to ICER’s mission either.

After lunch, we had a Q&A session, along with voting. This was when members of the council (I’m one) voted on the effectiveness and value of  various combinations of therapies for refractory multiple myeloma.

I write often about how we pay too much for care. I thought, going into this, that I would be arguing that these therapies were too expensive to be considered better than “low” value.

However, unlike many things which have questionable effectiveness, these medications do work in trials. They extend life, or time until progression, a real number of months or years. Yes, they cost hundreds of thousands of dollars per QALY, but we spend far more on that for many things that don’t work nearly as well.

At the end of the day, I voted to pretty much all of the therapies to have “intermediate value”. They’re not high value, cause they ain’t cheap, but they’re also not a waste. Most of the committee seemed to agree with me.

I was struck by how, when all of this was said and done, there didn’t seem to be much to be fear. No one suggested that we refuse to pay for these therapies. No one suggested that they weren’t “worth it”. We argued, and everyone seemed to agree, that we have got to get a grip on how much these drugs cost, or someone, someday, wouldn’t be able to afford them, but no one talked about rationing them.

After a policy roundtable, with representation from many stakeholders, we ended with comments from the members of the council. Here were my thoughts:

I think everyone here can sense the trepidation amongst many here in the room about having conversations like this, and a number of people have brought up the four letter word “rationing”. But make no mistake – rationing occurs in our healthcare system every day, and many, many patients are denied the care they need – and you could argue, they deserve – every day. We can either continue to have those conversations in closed rooms where no one really has any input and no one really knows why decisions are made, or we can have them in the light. We can talk about them in public and at least try to debate them in the open.

You can watch the meeting, start to finish, here. My comments are at the end, around 5:43:00.

Aaron

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Earlier this week the Senate Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) Subcommittee took up its spending bill for fiscal year (FY) 2017, which was marked up today by the full Appropriations Committee.

Given Labor-HHS’s jurisdiction over so much of the health research enterprise, AcademyHealth has been carefully monitoring activity surrounding this bill – namely, what it means for health services research and, in particular, for the Agency for Healthcare Research and Quality (AHRQ), which last year was proposed for termination by the House Appropriations Committee and for a 35 percent reduction in budget by the Senate.

Following today’s markup, we’ve learned that the Senate Labor-HHS Subcommittee has proposed a $324 million allocation for AHRQ, a $10 million cut from the current level. This is a $40 million reduction from AHRQ’s $364 million in budget authority in FY15. The bill also includes a $2 billion increase for the National Institutes of Health (NIH) as well as significant increases for efforts to combat the opioid epidemic and antibiotic resistance. Learn more here.

While funding for all research is crucial, AcademyHealth is disappointed to see yet another cut to AHRQ’s already small budget. The work of AHRQ is uniquely positioned to help the nation address the rising costs of health care and to transform how we approach health and health care in this country. Every cut reduces our capacity to ensure patient safety, address waste and inefficiency, and ensure access to groundbreaking treatments and prevention. However, we also recognize that Congress is under extreme pressure to fund competing priorities whilst doing its best to keep the federal budget in check—these are difficult choices made more necessary by the austere spending caps presently in place.

We hope that when the House Labor-HHS Subcommittee marks up its own spending bill they will remember AHRQ’s mission to find savings in care and enhance efficiency, affordability, safety, and accessibility, and will consequently act to preserve full funding for this critical agency.

AcademyHealth will be following appropriations developments in the House and Senate closely, and stands ready to act on behalf of our members and the field. As we look to the future, we look not only to save AHRQ, but to save the critical health services research that stands to drastically and positively shape the trajectory of U.S. health care.

View the full bill here.

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By Clare Roche, AcademyHealth

Conference networking tends to carry a stereotypical connotation: rushed attendees swarming around coffee carts attempting to make small talk before scurrying off to the next breakout room. In fact, many attendees forego the scheduled networking time entirely, opting to catch up on email or meander the exhibit halls instead. Even with scheduling esteemed plenary and session speakers, conference organizers strategically allocate time for networking breaks for the attendee’s benefit. These breaks are intended to foster new relationships as well as capitalize – face-to-face – on existing ones.

Prior to any networking function, it is important to remember a few simple tips and tricks that can elevate your conference networking-game.

  1. Have a numerical goal of new people or organizations you’d like to connect with during the conference. Remember that these connections do not always have to happen organically within the hours of the conference. Try to pre-schedule a few meetings to relieve some of the pressure. And, quality is better than quantity, so be realistic with this goal (e.g. making a meaningful connection with 3 people per day).
  2. Pack your business cards … and don’t be afraid to use them! Have a stack readily available in all of your meeting materials. In addition to exchanging information during scheduled meetings, you never know who you may meet in a session or the exhibit hall.
  3. Specifically, at this year’s Annual Research Meeting (ARM), we’re providing our loyal members with distinguished member ribbons. Stop by the AcademyHealth booth to pick up yours and begin connecting with your association peers.

The ARM is already breaking registration records, which means the pool of participants accessible to network within Boston is not only diverse, but also abundant. Currently, there are scheduled thirty-minute breaks on Sunday, June 26 and Monday, June 27 allotted for networking. This year we’re encouraging you to make an in person connection rather than an electronic one. Trust us, they last longer.

To assist you with partaking in our “out of the box” idea of networking breaks, we recommend you literally get out of the box (aka Hynes Convention Center). Below you’ll find a list of nearby places you can visit with a colleague during your thirty minutes, and still make it back in time for the next session.

338 Newbury Street, Boston, MA 02115

This café is located one block from the convention center. It’s so close you’d even have time to grab a quick bite.

  • Charles River Basin

Head North on Gloucester St. toward Back St. until you see the River Basin

Looking to stretch your legs? Take your meeting to go as you make your way to the water. This walk is ten minutes each way, allowing you some time to take in Boston’s beauty.

49 Massachusetts Ave, Boston, MA 02115

Bond with your mentor over your sweet tooth(s)! Named one of the best 101 cupcakes in America by The Daily Meal, you won’t leave disappointed.

Although the list of nearby options is endless, we encourage you to take that first step and choose just one. A change of scenery, good cup of coffee, or sweet treat can easily minimize the “work” aspect of networking, leaving you with a renewed outlook on a previously glanced over agenda item.

We’d love to hear your networking success stories from previous AcademyHealth Annual Research Meeting’s. In addition, if you have plans for Boston 2016, let us know by commenting below!

Clare Roche is the Student Membership and Chapter Coordinator at AcademyHealth where she manages all student chapters and student members, as well as coordinates the scholarships and awards programs. She encourages you to get involved with AcademyHealth through the formation of student chapters which enhance the learning and professional development experience for students in health services research and health policy. Clare graduated from the George Washington University as a double major in Communication and Business. Contact her at [email protected].

 

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