Voices in Health Care Value - June 2020

June 2020

Welcome to the seventh issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment (RC-HCVA). This issue features work from our colleagues at the Healthcare Value Hub. We appreciate your comments and inputs to subsequent issues. If you are interested in becoming a Colleague in Value (individuals and groups who work in this area or who are simply interested in its findings) please register here.

LEAD ARTICLE

RC-HCVA Announces New Grant Program for Health Care Value Research

By George Miller

With funding from the Pharmaceutical Research and Manufacturers of America (PhRMA), the Research Consortium for Health Care Value Assessment (RC-HCVA) announces the initiation of a new grant program to fund innovative policy research to stimulate awareness for the need to broaden how value in health care is determined, evaluated, and can be increased and replicated across the U.S. The long-term program will fund projects that vary by topic and award size, engage both new and established researchers, employ quantitative and qualitative methods, and are both empirical and conceptual. However, the first round of awards will support invited researchers to conceptually explore issues related to health care value in the context of the COVID-19 pandemic. These initial awards will address topics such as the following:

How can we continue to avoid the low-value services while resuming the high-value ones that have also been curtailed in the COVID-19 environment?
What novel financial policies can be introduced to counter attempts to increase low-value discretionary care for providers to re-coup lost revenues?
Will post-pandemic care do a better job of treating patients in appropriate settings, including via telemedicine? Will reimbursement policy evolve to site-neutral payments?
How can disparities that have been exacerbated by the pandemic be addressed in ways that deal with both the near-term exacerbations and the long-term underlying problems?
How will addressing and diminishing waste in health care expenditures help provide the headroom for addressing future health care crises? Can we, for example, do a better job reducing administrative waste?
The financial model for how hospitals generate revenue and stay solvent has been turned upside down during the pandemic. What would a new, improved financial model look like for hospitals going forward?

Because of the timeliness of these topics, the first round of grants will be awarded quickly and will support development of relatively short research briefs to be completed by the end of August 2020. We anticipate that the briefs will be published as a series in a health policy journal. In addition, grantees will be asked to summarize their results in a webinar to be held in September. Watch this space for further information, including the specific topics to be addressed and their authors, links to the final products, and the opportunity to register for the webinar which will be open to the public.

RESEARCH CORNER – In Case You Missed It

An article by Weng and colleagues published in JAMA Netw Open discusses their study on practice patterns of internists who relocate after residency. Their findings suggest the practice patterns of those who relocate tend to migrate toward the norms of the new region. Read full article here.
In an article by Christopher Robinson and colleagues published in PLoS ONE, they conclude that when looking at high-cost care, policymakers should be more concerned with foregone efficient spending for those lacking full insurance, rather than wasteful spending that occurs with those that have full insurance. Read full article here.
In this article by Ward and colleagues published in JAMA Open Network they discuss the differing practice patterns across the U.S. on total knee arthroplasty. Authors conclude there are different decision-making thresholds being used across the country suggesting overuse in some regions. Read full article here.
In this article by Judith Garber published by the Lown Institute, she discusses the silver lining of COVID-19 and the halting of elective surgeries and that impact on low-value care. Read full article here.
In this opinion piece by Ezekiel Emanuel and Amol Navathe published in The New York Times, they discuss a number of opportunities that the COVID-19 brings in terms of being able to reform our current health care system. Read full article here.
In this piece by Ani Turner, Corey Rhyan, George Miller and Paul Hughes-Cromwick published by Altarum, they discuss the impact that COVID-19 has had on health spending and jobs in the health sector. Identifying that for the first time the health care industry is not immune to an economic downturn. Read full article here.
In an article by Bouck and colleagues published in JAMA Internal Medicine, they discuss the association of downstream care for primary care patients that have received an initial low-value are test. Read full article here.
In an opinion piece by Rother, Spangler and Fendrick in The Hill, they discuss their perspective on how post COVID health care spending should be increasingly devoted to high value, evidence-based services, and less on low value care. Read full article here.

THE COMMUNITY – A Spotlight Feature on a Colleague in Value

In this issue of Voices in Health Care Value we highlight achievements in the sterling career of Dr. Michael Chernew. Dr. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and Director of the Healthcare Markets and Regulation Lab, Department of Health Care Policy at Harvard Medical School. He is co-founder of the V-BID Center at the University of Michigan and is a partner in VBID Health, which together with Altarum (with funding from the PhRMA Foundation), has created the Research Consortium for Health Care Value Assessment. On May 21, Dr. Chernew was named chair of the prestigious and influential Medicare Payment Advisory Commission (MedPAC). Prior to his Harvard appointment in 2006, he was on the faculty of the University of Michigan Department of Health Management and Policy, and the Department of Economics.

Dr. Chernew has been a thought-leader on health care economics for many years, contributing seminal work on important topics such as Value-Based Insurance Design; health care spending and utilization; alternative payment models; consumer-driven health care and shoppable services; and most recently national health expenditures in light of COVID-19. His work spans theoretical to policy-relevant analyses. A few of his recent articles are here:

Health Affairs – How to Read National Health Expenditure Projections in Light of COVID-19: Uncertain Long-Run Effects, But Challenges for All

Health Affairs – Transforming Medicare’s Payment Systems: Progress Shaped by the ACA

Health Affairs – Prices are Not “Reimbursements”

NEJM Catalyst Innovations in Care Delivery – How Different Payment Models Support (or Undermine) a Sustainable Health Care System: Rating the Underlying Incentives and Building a Better Model

The National Bureau of Economic Research – Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.

Health Affairs – What Do We Know About Prices and Hospital Quality?

NEJM – Health Care Spending, Utilization, and Quality 8 years into Global Payment

Brookings Hamilton Project – A Proposal to Cap Provider Prices and Price Growth in the Commercial Health Care Market

These are a small sample of the thought-leading articles that Dr. Chernew has authored in his prolific career. We congratulate Dr. Chernew on his appointment as Chair of MedPAC and look forward to many more important contributions from him.