Health Policy$ense

Policy Takes from AcademyHealth Conference

There’s an excellent group of articles in the LDIHealthEconomist by my colleagues who attended the recent AcademyHealth National Health Policy Conference. Together, they chronicle much of the excitement and frustration of this era of health care reform, and reflect next steps in the policy agenda to improve health and health care.  All are worth reading, but until you find the time, here are some brief highlights and excerpts.

Kathleen Noonan, on the future of CHIP (To CHIP or not to CHIP, that is the question)

AcademyHealth panel members pointed out that policymakers agree that the health insurance gains for children under CHIP should be maintained. The unresolved question is how to do this, given the known (and still unknown) gaps between CHIP and marketplace plans…

One panelist noted that, in the end, we held onto CHIP because of a fear of what would happen if it went away but that this fear should not get in the way of our innovating. Innovation would include thinking about merging CHIP and marketplace plans for children or returning to the idea of an expanded or alternate Medicaid program or allowing all workers and their families to obtain coverage through an exchange marketplace. What is not likely to produce the best result is experts and advocates choosing a camp and sticking to it before weighing the options.

Lisa Rosenbaum, on measuring performance and quality (The importance of what we can't count)

Something fundamental to the act of doctoring is at stake, and I can't help but wonder whether each effort to improve performance, however well intentioned, just further shifts the calculus away from doctor and patient, toward doctor and documentation. If we define quality based on mortality rates, readmissions, patient satisfaction scores, or lengths of stay, then we will pursue excellence in these measures. But is this what quality is really all about?

This is not a question I can answer in a short post, but I wanted to at least raise the issue. I am not suggesting that we, as health services researchers, stop doing all we can to study the impact of any given policy and its impact on metrics, like mortality rates, that, of course, matter. But I am suggesting that we push ourselves to consider what falls through the cracks of our data.

Zack Meisel, on engaging the public in thinking about cost and value (There's more to transparency than meets the eye)

This reticence to openly address cost and value has been a matter of political expediency. Many previous attempts have devolved into accusations of "rationing" and "death panels." Moreover, patients and consumers alike have been known to explicitly reject terms and ideas such as "value", and even "evidence-based decisions" when it comes to health…

Empowering patients to think about cost and value shouldn't be taboo. Doubtless, public sentiment will back policymakers, from either side of the aisle, who can help patients and consumers in this respect. Better data combined with better stories can create a win-win scenario for politicians, providers, payers and patients alike.

Pooja Mehta, on including women’s health in the conversation (The silence on reproductive health is deafening)

Lambrew's was just the first of two days of conference presentations marked by silence on women's health. It was a silence that confirmed the national health policy community's perception of a health reform agenda that explicitly embraces reproductive health as an inevitable political casualty of our current partisan environment…

Despite this charged context, policymakers and providers cannot simply give up on specifically incorporating reproductive health into mainstream discussions of our programmatic priorities, delivery innovations, and research agendas. Family planning is a key aspect of broader women's health that protects gender equality and autonomy, prevents maternal mortality, reduces costs attributable to unintended pregnancy, and is an important component of a healthy workforce.

Sunny Hallowell, on nursing’s role in improving child health (Toward a 3.0 upgrade of our child health system)

The afternoon closing plenary discussion refocused my thoughts about my clinical practice and research life. The work of great American women such as nurse and human rights activist Lillian Wald was used to remind the diverse audience about the unique and temporary state of childhood. The distinct needs of children should be recognized in the development of health policy, rather than the use of adult health policy adapted for children.

As one of the few nurses in attendance, the National Child Health Policy Conference left me hopeful that a year from now, when I come in from the capital cold, we will know much more about the impact of the ACA in achieving successful pediatric outcomes. Hopefully, we will also know more about the impact nurses have had on these outcomes and their collaboration in research and design of health policy.

There is so much more. Hoag Levins tells us about the surprise RWJF announcement about its Clinical Scholars Program; I give take-home messages on the neglected policy options in end-of-life-care; Brandon Maughan reports on the need to link price transparency and quality transparency; Loren Robinson gives us the not-business-as-usual view of health disparities; Elizabeth Brown reflects on non-physicians as part of the primary care workforce; and Charlene Wong delves into harnessing social media to figure out the #patientperspective (Is that a thing?)