Brookings: Topics - Health IT

Bending the Cost Curve in Health Care the Right Way—Through Better, More Person-Centered Care

Mark B. McClellan — Thu, 09 May 2013 13:54:00 -0400

The United States spends about 17 percent of GDP annually on health care, a figure that is projected to grow substantially in the years ahead, despite the recent slowdown in health care spending growth. Rising costs mean insurance coverage keeps getting more difficult to afford. Those rising costs, plus the aging demographics of the nation, account for most of the spending side of our nation’s long-term fiscal challenges at both the federal and state level. They mean higher expenditures on Medicare and Medicaid, and the tax subsidies for employer-provided coverage and the new subsidies for private insurance in the individual marketplaces. At the same time, biomedical innovation using genomics, systems biology, information technology, and innovative and convenient ways to deliver care holds the potential for much more effective, personalized care – if we can afford to develop and use it. That’s not the case so far: patients often do not get treatments we know to be effective, innovative treatments and ways of delivering care are hindered by payments that are tied more to the site of services and what we’ve paid for in the past than the value of these treatments for particular patients, and we often pay more for complications than for the coordination of care and person-focused support that could help health care providers and patients get much better results for the money they spend. Something has to change, not just to make sure that healthcare costs can be contained, but also to make sure that the quality of health care gets better by providing better support for what patients need.

Our new report, “Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth” is a system-wide framework to address our cost problems by improving care – by leveraging the large and growing opportunities for more person-focused care. We have developed a set of proposals for saving $1 trillion over 20 years and improving care at the same time. Written in collaboration with leading experts from across the academic and political spectrum, our report proposes a framework for how to improve health care financing and regulation so that we can achieve better, higher-value care for each person. The report describes a specific series of steps to improvement the way care is delivered in each part of our health care system, including Medicare and Medicaid, the employer and individual insurance markets, antitrust enforcement and other regulatory reforms. Focusing on person-level quality of care as the fundamental strategy for addressing health care cost growth is in some ways new, but it builds on promising ideas and trends throughout our health care system. It is an idea whose time as come, and which we should start to adopt as our long-term approach to addressing the health care quality and cost problems now.

This report is the third in our “Bending the Curve” series. While building on the past reports, it also differs from our previous work in some very important ways. First, we have broadened our group of authors. Still with us is the core group of experts who participated in previous reports – people like Joe Antos from AEI, Mike Chernew and David Cutler from Harvard, Mark Pauly from University of Pennsylvania, Dana Goldman from USC, Steve Shortell from UC Berkeley, and others who have a tremendous amount of health policy expertise and experience. We’ve also benefitted from some new expert perspectives, including Kate Baicker from Harvard. And along with that expertise, our group now includes some other experts with extensive policy and political experience – including NGA director Dan Crippen, former Senate Majority Leader Tom Daschle, former CEA chair and Columbia dean Glenn Hubbard, former Utah Governor and former HHS Secretary Mike Leavitt, former HHS Secretary and University of Miami President Donna Shalala, and former budget directors Peter Orszag and Alice Rivlin. Together, this unique group sparked a new and welcome level of discussion about reform. In particular, as Mike Leavitt put it, if Republicans and Democrats were at the point where they had to reach an agreement on reforming care and addressing the challenge of rising costs, what would they agree on – and how could we make sure it would work?

As we worked to answer these very practical questions, we were forced to consider the full range of key technical and political issues involved in health reform. We reviewed the kinds of reforms that we have considered before to improve quality and lower costs, along with new evidence on how those reforms and others being implemented now are working (with different degrees of success) in the public and private sectors. We combined that with consideration of how best to move forward in a way that avoids the need for disruptive short-term payment cuts, provides the policy certainty needed to accelerate the trends toward the availability of much better, more personalized care, and addresses serious short-term weaknesses in in Medicare, including unstable physician payments and a lack of support for beneficiaries to save money when they get better care These considerations led to a plan that involves implementing reforms that are not disruptive in the short term while supporting better quality and coordination of care, leading to a large impact over time on supporting improvements in care that can sustain slower cost growth in the years ahead. Our conclusion is that enacting these health care reforms will not be easy, but we agree that this is the best path forward.

We do need to act now. If enacted, our framework is able to avoid the more aggressive steps that will almost certainly be needed in the years ahead to achieve more urgent reductions in federal spending, like cuts in payment rates as in sequestration, or restrictions in coverage for vulnerable populations and in access to new types of innovative care. And even more importantly, it will speed up the innovations in health care and biomedical technology that lead to better results and lower costs for patients. The bottom line is that the best way to control health care costs is to have health care policies now that do as much as possible to support better care for each patient.

We have a window of opportunity right now for implementing thoughtful health care financing and regulatory reforms that improve care today and promote much better, person-centered health care for the future. This is the best way for the country to achieve its overall deficit reduction targets. We should act now before the window closes, and we are left only with policy options that shift costs, reduce quality, and most importantly, diminish the ability of patients and health care providers to achieve better care and better health.

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Authors

Mark B. McClellan

Image Source: © Keith Bedford / Reuters

Accessing and Communicating Device Information: UDI as a Tool for Improved Patient and Provider Connectivity

Mon, 18 Mar 2013 09:00:00 -0400

Event Information

March 18, 2013
9:00 AM - 3:45 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

Accessing and Communicating Device Information: UDI as a Tool for Improved Patient and Provider Connectivity

On Monday, March 18, 2013, the Engelberg Center for Health Care Reform at Brookings convened a diverse group of patient groups, providers, academic researchers, and other relevant stakeholders to discuss unique device identification (UDI) as a tool for improving the flow of important device information between and among patients and providers.

At the initial UDI Implementation Work Group meeting and throughout ongoing conversations with the Work Group and other experts, stakeholders emphasized the importance of facilitating seamless communication of device safety information, easy access to important device information for patients and providers, and improved communication regarding devices between patients and providers. Although enabling each of these capabilities will likely require the adoption of UDI by an array of stakeholders (e.g., health care systems capturing UDIs in electronic health records), participants emphasized that patients and providers will likely benefit most from and, therefore, should have an important role in the development of the UDI system. However, participants also recognized that the task of realizing the vision of an effective UDI system is not trivial and will require broad stakeholder input and focus. This workshop provided an opportunity for stakeholders to consider what will likely be the most pressing challenges and workable strategies for achieving these enhanced capabilities.

Event Materials

Highlights from the Fifth Annual Sentinel Initiative Public Workshop

Thu, 07 Mar 2013 14:30:00 -0500

Event Information

March 7, 2013
2:30 PM - 3:30 PM EST

Live Webinar
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

On March 7, the Engelberg Center for Health Care Reform at Brookings hosted a roundtable webinar, “Highlights from the Fifth Annual Sentinel Initiative Public Workshop.” This webinar featured presentations from Dr. Patrick Archdeacon, a medical officer in the Office of Medical Policy at the U.S. Food and Drug Administration, and Dr. Richard Platt, professor and chair of the Department of Population Medicine at Harvard Medical School and executive director of the Harvard Pilgrim Health Care Institute.

This webinar provided an opportunity for stakeholders to revisit the discussions from the Fifth Annual Sentinel Initiative Public Workshop, which included an update on the status of Mini-Sentinel activities and the progress and future directions of the Sentinel Initiative.

Audio

Highlights from the Fifth Annual Sentinel Initiative Public Workshop

Event Materials

Presentation

Improved Access to Device Information:What a UDI System Can Do for Patients and Consumers

Tue, 26 Feb 2013 12:00:00 -0500

Event Information

February 26, 2013
12:00 PM - 1:30 PM EST

Webinar
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

On February 26, 2013, the Engelberg Center for Health Care Reform at Brookings hosted a webinar entitled “Improved Access to Device Information: What a Unique Device Identification (UDI) System Can Do for Patients and Consumers.” Successful UDI implementation offers a number of potential benefits for patients and consumers, including faster detection of safety concerns associated with specific devices, more efficient communication between providers and patients regarding important medical device information, and independent patient access to information regarding their devices. However, the value of UDI implementation will not be fully achieved without broad stakeholder support and adoption. Patients and consumers have a large stake in this effort and can help shape UDI implementation efforts in important ways. This webinar explored the value of UDI for patients and consumers as well as the potential role they can play in shaping and driving UDI implementation.

Audio

Improved Access to Device Information:What a UDI System Can Do for Patients and Consumers

Event Materials

UDI Expert Workshop #2: Identifying Steps for Implementation and Integration of UDI within Electronic Data Infrastructure of Care Delivery Sites

Thu, 13 Dec 2012 09:00:00 -0500

Event Information

December 13, 2012
9:00 AM - 4:00 PM EST

Saul/Zilkha Rooms
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

Identifying Steps for Implementation and Integration of UDI within Electronic Data Infrastructure of Care Delivery Sites

On Thursday, December 13, 2012, the Engelberg Center for Health Care Reform at the Brookings Institution convened a diverse group of providers, vendors, medical device manufacturers, academic researchers, and other relevant stakeholders with important roles throughout the medical device lifecycle to discuss workable strategies for meaningfully integrating unique device identifiers (UDIs) into and across administrative and clinical data systems within health care delivery sites.

At the initial UDI Implementation Work Group meeting, stakeholders emphasized the importance of integrating UDI into the electronic data infrastructure at health care delivery sites to enable an array of benefits, including streamlining the supply chain, providing access to device information to inform provider decision-making, and creating enhanced mechanisms for device safety surveillance and effectiveness evaluation. Despite these potential benefits, achieving this goal is not trivial and will require broad stakeholder input and focus. This workshop provided an opportunity for stakeholders to consider what incentives could be used to drive incorporation of UDI into administrative and clinical data systems within health care delivery sites, potential obstacles that will need to be anticipated, and paths forward for integrating UDI recording into and across these systems without disrupting workflow.

Event Materials

Developing a Taxonomy of Surveillance Methods for Medical Product Safety

Fri, 07 Dec 2012 14:00:00 -0500

Event Information

December 7, 2012
2:00 PM - 3:00 PM EST

Live Webinar
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

On December 7, 2012, the Engelberg Center for Health Care Reform at Brookings held a webinar on “Developing a Taxonomy of Surveillance Methods for Medical Product Safety.” This webinar explored how the classification of surveillance methods allows for researchers to determine the most suitable methodology for monitoring medical product safety scenarios. This classification has helped to provide clear and practical guidance for methods selection in active medical product surveillance. Dr. Joshua Gagne highlighted progress in categorizing medical product safety scenarios and developing structured decision tables for methods selection. Dr. Meghan Baker provided an overview of a methods framework for vaccine-specific safety monitoring.

Audio

Developing a Taxonomy of Surveillance Methods for Medical Product Safety

Event Materials

Taxonomy Webinar Presentation

New Policy Directions for Biomedical Innovation

Mon, 19 Nov 2012 13:30:00 -0500

Event Information

November 19, 2012
1:30 PM - 3:30 PM EST

Saul/Zilkha Rooms
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

Register for the Event

On November 19, the Engelberg Center for Health Care Reform at Brookings hosted an event examining the outlook and opportunities for biomedical innovation in a challenging fiscal environment. Leaders in the field offered their thoughts on future directions of and policy priorities for the innovation enterprise. Following a brief keynote, a panel of senior thought leaders provided further discussion on actionable next steps to improve biomedical innovation.

Download the executive summary » (PDF)
Download the panelist biographies » (PDF)

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Audio

New Policy Directions for Biomedical Innovation

Transcript

Uncorrected Transcript (.pdf)

Event Materials

The Value of Unique Device Identification (UDI) for Health Care Systems and Providers

Mon, 05 Nov 2012 14:00:00 -0500

Event Information

November 5, 2012
2:00 PM - 3:30 PM EST

Live Webinar
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

On November 5, 2012, the Engelberg Center for Health Care Reform at Brookings hosted a webinar on “The Value of Unique Device Identification (UDI) for Health Care Systems and Providers.”

Experts have highlighted a variety of enhanced capabilities that could arise from UDI adoption and implementation. For example, UDI implementation offers health care systems and providers the opportunity to streamline internal supply chains, conduct more effective recall management, and improve access to device information. This webinar explored the operational, financial, and clinical value of UDI implementation for health care systems and providers.

Audio

The Value of Unique Device Identification (UDI) for Health Care Systems and Providers

Event Materials

UDI Webinar 1 Presentation

UDI Expert Workshop #1: Exploring the Opportunities and Challenges Associated with Capturing UDIs in Claims

Mon, 15 Oct 2012 09:00:00 -0400

Event Information

October 15, 2012
9:00 AM - 4:00 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue, N.W.
Washington, DC 20036

Exploring the Opportunities and Challenges Associated with Capturing UDIs in Claims

On October 15, 2012, the Engelberg Center for Health Care Reform at the Brookings Institution convened a diverse group of experts, including payers, providers, academics, medical device manufacturers, and other relevant stakeholders, for a productive discussion on capturing unique device identifiers (UDIs) in administrative health care claims.

Electronic health care claims data have increasingly played an important role in a range of activities related to drugs and other health care services, including active drug safety surveillance, evaluation of patterns of care and effectiveness, and identification of opportunities for improvements in the quality of care that patients receive. During the initial meeting of the UDI Implementation Work Group, participants emphasized that if UDIs were captured in claims, similar activities may become more feasible for medical devices. However, overcoming the technical and motivational challenges associated with incorporating UDIs into claims is not trivial. Broad stakeholder input will be required and this expert workshop was designed as an initial forum for discussion. Specifically, this workshop provided an opportunity for stakeholders to consider the potential benefits of capturing UDIs in claims, associated technical challenges, and appropriate policies to support consistent UDI reporting in claims.

Event Materials

Unique Device Identification (UDI) Implementation Work Group Kick-Off

Mon, 16 Jul 2012 09:30:00 -0400

Event Information

July 16, 2012
9:30 AM - 4:00 PM EDT

The Stein Room
The Brookings Institution
1775 Massachusetts Ave., N.W.
Washington, DC 20036

On July 16, 2012, the Engelberg Center convened a small work group of experts representing key stakeholder groups, including device manufacturers, payers, electronic health record vendors, academics, clinicians, and others with a vested interest in UDI implementation. This Work Group convened for an initial in-person meeting at Brookings where the group delved into the major use cases that should be the focus of initial UDI implementation efforts, explored major challenges to implementation, and identified those that could benefit from greater attention during subsequent expert workshops.

Recently, the U.S. Food and Drug and Administration (FDA) released its Proposed Rule outlining a system of unique device identifiers (UDIs). The Engelberg Center for Health Care Reform at Brookings is beginning work to support the implementation and full adoption of UDIs across the medical device lifecycle. Initiated in cooperation with FDA and Chickasaw Nation Industries, Inc. as part of the Medical Device Epidemiology Network (MDEpiNet) program, this work will help identify, prioritize, and explore the most pressing issues pertaining to UDI implementation.

Event Materials

Participants

Panelists

Gregory W. Daniel

Managing Director for Evidence Development & Innovation, Engelberg Center for Health Care Reform
Fellow, Economic Studies

Mark B. McClellan

Director, Engelberg Center for Health Care Reform
Senior Fellow, Economic Studies
Leonard D. Schaeffer Chair in Health Policy Studies

State of Biomedical Innovation Conference

Wed, 27 Jun 2012 09:00:00 -0400

Event Information

June 27, 2012
9:00 AM - 12:30 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue, N.W.
Washington, DC 20036

On June 27, the Engelberg Center for Health Care Reform at Brookings hosted the State of Biomedical Innovation Conference in Washington, DC. Designed to bring together diverse stakeholders and senior thought leaders from across the biomedical enterprise, this event engaged participants in discussion on the health of biomedical innovation in the United States, obstacles to innovation, policy options for overcoming those obstacles, and key metrics that can be used to evaluate whether the U.S. biomedical enterprise is effectively delivering new and innovative medical products to the patients who need them.

Panelists included distinguished experts, industry leaders, policymakers, and regulators. After each panel, participants took audience questions.

Video

Event Materials

How Mobile Devices are Transforming Healthcare

Darrell M. West — Tue, 22 May 2012 00:00:00 -0400

Editor's Note: This report is being released in conjunction with an event at Brookings as part of the Mobile Economy Project.

In this new paper, Darrell West writes that mobile technology has expanded dramatically around the world with the utilization of smart phones and tablets transforming communications, commerce, and entertainment, among other fields. Their emergence has improved service delivery, empowered consumers, businesses, and entrepreneurs, and changed the way in which people access information and make transactions.

Now this technology, West argues, is poised to alter how health care is delivered, the quality of the patient experience, and the cost of health care.^[1] Mobile technology is helping with chronic disease management, empowering the elderly and expectant mothers, reminding people to take medication at the proper time, extending service to underserved areas, and improving health outcomes and medical system efficiency. West examines trends in mobile health innovation from around the world and reviews adoption of innovative examples of m-health, its impact on service delivery and medical treatment, and how mobile devices are altering the health care system.

[1] Hao Wang and Jing Liu, “Mobile Phone Based Health Care Technology”, Recent Patents in Biomedical Engineering, Volume 2, 2009, pp. 15-21.

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Authors

Darrell M. West

Image Source: Lester Lefkowitz

How Mobile Technology Influences Health Innovation

Tue, 22 May 2012 14:00:00 -0400

Event Information

May 22, 2012
2:00 PM - 3:30 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue, N.W.
Washington, DC 20036

Mobile technology has transformed the way that individuals accomplish everyday tasks like finding directions, paying bills, and communicating with friends. But mobile technology has also changed the way individuals interact with the medical system around the world. With technological advances, health providers are now able remotely to monitor diabetic and heart patients, send email reminders to take medications, and access diagnostic databases through mobile devices. How have these innovations contributed to patient health and enhanced the doctor-patient relationship? What mobile health advances are transforming medical care? How are countries around the world using mobile technology to improve health care delivery and save money?

On May 22, the Center for Technology Innovation at Brookings held a public forum as part of its Mobile Economy Project to evaluate mobile technology’s influence on healthcare. A panel of experts discussed how mobile technology is enabling health innovation both in the United States and around the world. After the program, speakers took audience questions. Darrell West also released a new paper on the topic.

Participants

Panelists

Julie Kling

Mobile Executive Business Lead, Strategic Communications

Alain Labrique

Assistant Professor, Departments of International Health and Epidemiology

Antonio Marttos Jr., MD

Assistant Professor, Surgery; Director, Global e-Health Co-Director, William Lehman Injury Research Center

Morgan Reed

Executive Director, Association for Competitive Technology

Bringing Health Care into the 21st Century

Wed, 09 May 2012 08:30:00 -0400

Event Information

May 9, 2012
8:30 AM - 1:00 PM EDT

Falk Auditorium
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

The United States faces many challenges in terms of health care quality, affordability and access. The nation spends almost twice the percentage of its gross domestic product as many European countries on health care, but has outcomes that rank well below those of other developed nations. However, policy ideas and new technologies are emerging to improve innovation, data sharing, and analytics, thereby boosting cost containment and health care delivery and quality.

On May 9, the Governance Studies program at Brookings hosted a half-day conference focused on government reforms and technology-related solutions aimed at improving the U.S health care system. The third annual A. Alfred Taubman Forum on Public Policy convened leaders from academia, business and government to discuss concrete policy actions to improve performance in this policy area and specific actions to modernize the U.S. health care system for the 21st century.

Audio

Bringing Health Care into the 21st Century

Participants

Panelists

Curt I. Civin, MD

Associate Dean for Research and Director, Center for Stem Cell Biology & Regenerative Medicine
University of Maryland School of Medicine

Grant Verstandig

Founder & CEO
Audax Health

Kevin Vigilante, MD

Senior Vice President
Booz Allen Hamilton

Daniel J. Wattendorf, Lt Col, USAF, MC

Program Manager, Defense Sciences Office
Defense Advanced Research Projects Agency

Lynn Etheredge

Principal Consultant, Rapid Learning Health System Project
The George Washington University

Richard Migliori, MD

Executive Vice President, Health Services, United Health Group
Chief Healthcare Officer, United Health Group Alliances

William Haseltine

President
Access Health International

Robert Jarrin

Senior Director, Government Affairs
Qualcomm

Campaign 2012: The Future of Health Care

Fri, 04 May 2012 13:00:00 -0400

Event Information

May 4, 2012
1:00 PM - 2:30 PM EDT

Falk Auditorium
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

As America confronts the realities of an aging population and a federal budget deficit, methods for containing health care costs while improving the quality and access of care are critically important. With the Supreme Court now considering its constitutionality, the fate of the Affordable Care Act is in doubt, and Medicare costs are projected to rise rapidly. As the presidential candidates look toward the next four years, which reforms are most urgent, and is there sufficient political will to implement them? Can investments in information technology and public health make health care better and more cost-effective?

On May 4, the Campaign 2012 project at Brookings held a discussion on health care reform, the fifth in a series of forums to identify and address the 12 most critical issues facing the next president. David Nather of POLITICO Pro moderated a panel discussion with Brookings experts Alice Rivlin, Ross Hammond, Thomas Mann and Mark McClellan.

Video

Audio

Campaign 2012: The Future of Health Care

Event Materials

Participants

Panelists

Moderator: David Nather

Health Care Editor
POLITICO Pro

Health Information Exchanges and Megachange

Allan A. Friedman and Darrell M. West — Wed, 08 Feb 2012 00:00:00 -0500

Editor's Note: In this paper, Darrell West and Allan Friedman study how state-level health information exchanges (HIEs) are implemented, where there are opportunities for action and who drives policy change. This paper looks at the current climate for organizational change and study the challenges faced by HIEs and how new technology is moving forward to overcome them; the scholars argue that for these megachange efforts to be effective, policymakers must present a clear vision, achieve consensus on key objectives, overcome organizational and market fragmentation, and work effectively with a range of different constituencies. In particular, this paper addresses the effectiveness and viability of HIE’s in Indiana, Massachusetts, New York, Tennessee, and California and explores why Massachusetts and Indiana are most successful across a number of metrics. CTI also hosted a forum on HIEs to discuss the paper.

Executive Summary

The United States faces a number of large-scale policy challenges. Economic development, job creation, deficit reduction, tax reform, health care, immigration, and national security all represent areas of high political, policy and organizational complexity. Each one faces enormous contentiousness over vision, goals, strategies, and tactics. There is little agreement on basic approaches to these policy subjects, and there are multiple organizations and government jurisdictions involved in administration and implementation. The sheer complexity of action in these areas makes it difficult to resolve conflict and implement effective solutions.

In this paper, we analyze state health information exchanges (HIEs) as an example of what MITRE researcher John Piescik calls “megachange” challenges.[ii] According to the U.S. Department of Health and Human Services, HIEs are “efforts to rapidly build capacity for exchanging health information across the health care system both within and across states.”[iii] This includes insurance information for those without coverage and clinical and medical data in order to connect health care providers and payers. The goals are to increase the flow of information across relevant organizations and improve the efficiency and effectiveness of the health care system.

These organizational innovations are an interesting example of policy change in a big and complex area. Health care represents nearly one-sixth of the overall economy and has costs that are growing well beyond the inflation rate. There are multiple actors such as patients, physicians, hospitals, vendors, payers, and advocacy organizations that are important to health care. It generally has been difficult to forge policy agreements among the various constituencies who are involved in this domain.

To develop a better understanding of megachange and health care, we look at a variety of questions. Using interviews, case studies, and documentary research, we study how state-level HIEs are implemented, what drives policy and organizational change, what the opportunities for action are, what barriers come up, and how HIEs are moving forward to overcome particular problems.

Briefly, we find that state health information exchanges have made progress in establishing organizational frameworks, building technology-based connections, and bringing relevant groups to the table for discussion. However, barriers remain in terms of governance, financing, and policy vision. Many states and localities have experienced difficulties in producing consensus on strategies and approaches, and identifying consistent revenue streams. Some question whether the state level is the proper unit for HIEs given natural marketplaces centering on localities or regions. Until those problems are overcome, it will be impossible for HIEs to achieve their full potential.

These findings have ramifications for U.S. efforts to bring large-scale change to many different policy areas. Our analysis suggests that for megachange efforts to be effective, policymakers must present a clear vision, achieve consensus on key objectives, overcome organizational and market fragmentation, and work effectively with a range of different constituencies. There needs to be adequate financial resources and sustainable business models to support proposed changes and public and private leaders must have incentives to work well together in relationships based on mutual trust.

Download full paper » (PDF)

References

[i] Kent Weaver, “But Will It Work?: Implementation Analysis to Improve Government Performance,” Issues in Governance Studies, February, 2010.

[ii] John Piescik, “Megachange: Leading Change Across Multiple Large Organizations,” McLean, Virginia: MITRE Center for Enterprise Modernization Technical Report MTR070320, November, 2007.

[iii] U.S. Department of Health and Human Services, “State Health Information Exchange Cooperative Agreement Program,” August 10, 2011.

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Authors

Image Source: Bluestocking

Policy Megachange and Health Information Exchanges

Wed, 08 Feb 2012 10:00:00 -0500

Event Information

February 8, 2012
10:00 AM - 11:30 AM EST

Falk Auditorium
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

Health care represents nearly one-sixth of the overall U.S. economy and has costs that are growing well beyond the inflation rate. Because multiple actors such as patients, physicians, hospitals, vendors, payers, and advocacy organizations are important to health care, it has been difficult to enhance communication channels among these constituencies.

Health information exchanges represent one way to improve capacity to share data. State health information exchanges have made progress in establishing organizational frameworks, building technology-based connections, and bringing relevant groups to the table for discussion. However, barriers remain in terms of governance, financing, and policy vision. Many states and localities have experienced difficulties in producing consensus on strategies and approaches, and identifying consistent revenue streams.

On February 8, Darrell West, vice president and director of Governance Studies and founding director of the Center for Technology Innovation, moderated a conversation on the issues surrounding implementation of health information exchanges. Panelists Janet Marchibroda, John Piescik, Jon White, and Claudia Williams discussed mechanisms to increase the flow of information across relevant organizations and improve the efficiency and effectiveness of the health care system.

In addition, West, with Allan Friedman, released a new paper, "Health Information Exchanges and Megachange."

Following the program, panelists took questions from the audience.

This event was live-tweeted using the hashtag #TechCTI.

Audio

Policy Megachange and Health Information Exchanges

Transcript

Uncorrected Transcript (.pdf)

Event Materials

20120208_health_information_exchanges

Participants

Panelists

Janet Marchibroda

Chair, Health Information Technology Initiative
The Health Project at the Bipartisan Policy Center

John Piescik

Strategy and Engagement Leader, Center for Transforming Health
The MITRE Corporation

P. Jon White

Director, Health IT
Acting Director, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality

Claudia Williams

Director, State Health Information Exchange, Office of the National Coordinator
U.S. Department of Health and Human Services

Evaluating Community-Based Reforms in Care for Chronic Conditions: A Multi-Payer Template for Information Technology Initiatives

Thu, 29 Dec 2011 00:00:00 -0500

Executive Summary

Community-level interventions have the advantage of facilitating system-wide delivery and payment reform because they shift the focus of reform efforts away from particular institutions to the broader community where patients receive their care and manage their conditions, thus facilitating greater care coordination across settings. Community-based initiatives, however, have created a new set of methodological challenges around how best to determine whether and to what extent these initiatives have had an impact on cost and quality and, where they have, determining what worked and what could have worked better.

The challenge of evaluation derives from the nature of community-based innovation. Initiative design and primary objectives may vary in different communities, given different priorities and the types of available resources; typically lack randomization and control in an environment where patients may elect to participate in innovative programs non-randomly based upon characteristics that affect measured health outcomes; proceed in a dynamic environment, where many things may be changing simultaneously; and they may have differential, and sometimes completely opposite effects, on subsets of the population, in a setting where there is very limited opportunity to evaluate the impact on some of those subsets. The risk in that setting is that apparent improvements in an outcome, such as cost, in one population (e.g., Medicare enrollees) may be the consequence of cost-shifting to an unobserved population (e.g., commercial enrollees) rather than the result of genuine improvements in the efficiency with which care is delivered.

To begin to address these challenges, the Engelberg Center for Health Care Reform at Brookings has worked closely with three communities, the Primary Care Information Project (PCIP) in New York City, Vermont’s Blueprint for Health (Blueprint) and the Wisconsin Health Information Organization (WHIO) , and analysts from the Dartmouth Institute, New York University, Onpoint Health Data and OptumInsight (formerly Ingenix) to develop a multi-payer template for evaluating their ongoing and future community-based health care reform initiatives. The objective was to better equip these communities to conduct rigorous evaluation of the impact of their interventions on the cost, quality, and utilization of health care and to provide a template that would enable other communities implementing accountability-based multi-payer payment and delivery system reform initiatives to understand how they might do so.

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Authors

Cary Sennett, MD, PhD
Karen Matsuoka, DPhil, MPhil
S. Lawrence Kocot
Mark B. McClellan
Molly Chidester

Comments on the Proposed Rulemaking for the Medicare Shared Savings Program

Mon, 06 Jun 2011 00:00:00 -0400

The Engelberg Center and the Dartmouth Institute for Health Policy & Clinical Practice submitted comments to the Centers for Medicare & Medicaid Services on the Medicare Shared Savings Program Notice for Proposed Rulemaking (NPRM) and on the waiver designs in connection with the Medicare Shared Savings Program and the Innovation Center.

The Engelberg Center and the Dartmouth Institute have long advocated for the development of new payment models – including the concept of accountable care organizations (ACOs) – in order to support provider efforts to deliver better care to patients. As when we first advocated for a Medicare ACO program several years ago, the goal remains a simple one: to help physicians, hospitals, and other health care providers – whether in the public sector or private sector – deliver high-value care by providing support to allow them to work together to improve quality while lowering costs. Currently, many steps that improve care and lower overall costs are reimbursed either poorly or not at all by Medicare, making it difficult for providers to sustain steps to improve their delivery of care.

The path toward implementing accountable care will not be easy for health care organizations or Medicare, Medicaid, and private payers. The transition toward integrated, coordinated and accountable care requires investments in health information technology that supports measurement for both improvement and accountability; the development of care management programs that allow teams comprised of nurses, pharmacists and other health professionals to deliver the right care to the right patient and maintain health while preventing costly complications of chronic diseases; the effective coordination of care – especially for the frail elderly or for those with multiple chronic conditions – across clinicians and sites of care; and governance and leadership structures that can strategically deploy the resources and project management required to implement these new models of care. These activities take considerable time, effort, and money. In addition, the steps must be implemented in a way that, over time, achieves reductions in health care costs. Thus, effective payment reforms must provide both new financial support for effective investments to improve care, and lead to evidence of meaningful cost savings and quality improvement. Further, these efforts must occur in a way that promotes beneficiary involvement. Though these changes are not easy, the ACO program and related – hopefully reinforcing – Medicare payment reforms are essential for supporting needed steps by providers to continue to improve care.

Read the full comments on proposed rulemaking for the Medicare Shared Savings Program

Read the full comments on the waiver designs in connection with the Medicare Shared Savings Program and the Innovation Center