Voices in Health Care Value - September 2020

September 2020

Welcome to the ninth 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 Pharmaceutical Value (pValue) – headquartered within the University of Colorado’s Anschutz Medical Campus. 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


RC-HCVA Announces a New Blog Series: Higher Health Care Value Post COVID-19

By George Miller

With funding from the Pharmaceutical Research and Manufacturers of America (PhRMA), the Research Consortium for Health Care Value Assessment (RC-HCVA) has established a grant center to support research projects that address issues in health care value.1 The first initiative of the center has been to fund seven short and timely projects on issues related to enhancing health care value in the context of the COVID-19 pandemic. Each project has resulted in a short report to be published in a Health Affairs Blog series this fall. The researchers will also present their work in a webinar that is free and open to the public on October 8, 2020 from 1:00 to 3:00 PM EDT. Registration for the event can be found here.2

The series addresses a broad spectrum of topics in health care value in the context of the COVID-19 pandemic and its aftermath. In Taming the Paper Tiger, David Cutler (Harvard University) describes reasons for high administrative costs in health care, discusses the need to reduce them, and presents ideas for addressing the issue, which persists during the pandemic and will continue after it has been controlled.

The pandemic has resulted in unprecedented adoption of telehealth services as a safe way to deliver health care for some services without the risks inherent in in-person contacts. Christina Cutter, Nicholas Berlin, and Mark Fendrick (University of Michigan) propose policy and research agendas to inform a value-based approach to continuing the use of telehealth in a post-pandemic environment in their report titled Establishing a Value-Based “New Normal” for Telehealth.

As manufacturers work on treatments, cures, vaccines, and diagnostics to address COVID-19, researchers have begun to consider how these new technologies should be priced. In Applying Value Assessment to the Health Care Sector for COVID-19, William Padula (University of Southern California) describes problems with using traditional cost-effectiveness analysis to inform such price setting and proposes an alternative method based on budget impact analysis.

COVID-19 has resulted in major swings in the provision of elective clinical services. Bruce Stuart (University of Maryland, Baltimore) describes this phenomenon, considers how the supply of such services is likely to be affected once the crisis is over, and discusses a number of relevant policy issues in How the COVID-19 Pandemic Has Affected Provision of Elective Services by American Health Care Providers: The Challenges Ahead.

Two of the research projects have addressed the natural experiment that has resulted from the reduction in both high- and low-value care that has occurred in the context of the pandemic. In Opportunities to Improve Value in Health Following the COVID-19 Pandemic, Kevin Griffith and Melinda Buntin (Vanderbilt University) describe several experimental designs to improve our understanding of this reduction in wasteful services and consider ways to address it post pandemic. In The COVID-19 Pandemic Can Help Us Understand Low-Value Health Care, Jodi Segal (Johns Hopkins University) and Allison Oakes (University of Pennsylvania) describes how this natural experiment can expand our understanding of low-value care and inform the development of a research agenda and policies to permanently reduce it.

Finally, the COVID-19 pandemic has highlighted the health disparities that persist throughout the U.S. health care system. Harold Pollack and Caroline Kelly (University of Chicago) explore some of the challenges that must be overcome to reduce these disparities and discusses steps to reduce them in preparation for the next public health crisis in their paper, COVID-19 and Health Disparities – Insights from Key Informant Interviews.

More information on the grant center and this initial series of studies will be forthcoming in future issues of Voices in Health Care Value and on the RC-HCVA website. In the meantime, we encourage interested readers to watch for these blogs in Health Affairs and to register for the October 8 webinar.

RESEARCH CORNER – In Case You Missed It

  • In this article by our Colleagues in Value at p-Value they describe their important work in multi-criteria decision analysis and the reimbursement decisions. Read the full article here.
  • In an article published in Health Affairs, Jason Buxbaum and colleagues this study used vital statistics data and cause-deletion analysis to identify the conditions (including public health, pharmaceuticals and other (non-pharmaceutical) medical care, and other unknown factors) contributed to the improvement of the changing life expectancy. Read the full article here.  
  • In an article published in the Journal of General Internal Medicine, Reid and colleagues provide an update on the national estimates of low-value service use and spending in Medicare in 2017. Read the full article here.
  • In this article published in NEJM, Corinna Sorenson and colleagues discuss the disruption that COVID-19 has had on our health systems and the opportunity it has presented to re-evaluate the necessity of services our health systems provide. Read the full article here.
  • In this article published in AJMC, Gianna Melillo provides insights into the webinar that discussed challenges that providers face during the COVID-19 pandemic and the opportunity to implement value-based care practices. Read the full article here.
  • In this article published in Health Affairs, Ayotomiwa Ojo and colleagues discuss the need for value-based health care system must also value black lives. Read the full article here.
  • In this article published in JAMA Netw Open, Anderson and colleagues discuss how their findings suggest that reducing low-value testing and utilization may need to include targeting ordering clinicians as well as public campaigns. Read the full article here.

    THE COMMUNITY – A Spotlight Feature on a Colleague in Value


Pharmaceutical Value (pValue) – headquartered within the University of Colorado’s Anschutz Medical Campus – aims to apply and test novel methods for value assessment that encourages stakeholder engagement and promotes value-based decision making. pValue is a recipient of the PhRMA Foundation’s Value Assessment Initiative Centers of Excellence Award.


Traditional measures of value used in cost-effectiveness analyses are not, by definition, fully comprehensive or sufficiently flexible to allow for the inclusion of all the criteria that patients, payers, clinicians, or other health care stakeholders care about. Multi-criteria decision analysis (MCDA) offers a scientifically rigorous decision-making tool capable of including multiple criteria that are important to stakeholders. MCDA has been applied in a variety of sectors, such as investment banking and environmental management, but applications in US healthcare decision making have been limited.

MCDA can improve decision making in health care by engaging key stakeholders and by capturing and weighing criteria not found in traditional measures of value, for example novelty, severity of disease, quality of evidence, and family burden.  By encouraging a comprehensive understanding of value, MCDA offers an opportunity to systematically weigh non-traditional aspects of value that fall outside traditional measures of value.

The University of Colorado’s pValue initiative will explore how MCDA can add information on value to improve decision making in health care.

Ongoing Activities

  • Review applications of MCDA and where it may show promise for use in coverage and reimbursement decision making
  • Educate stakeholder communities on MCDA techniques
  • Develop pilot MCDA tools for innovative therapies (e.g. rare diseases and oncology)
  • Partner with patient, payer, and clinician communities to identify and compare criteria that are important to them
  • Test impact of adding MCDA to traditional value assessments, versus traditional value assessment alone, on health care decision making
Key Staff 

R. Brett McQueen, PhD

Kavita V. Nair, PhD
Investigator Kavita.Nair@cuanschutz.edu

Jonathan D. Campbell, PhD
Former Director and Steering Committee Member

Melanie D. Whittington, PhD
Former Investigator and pValue collaborator



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1. We thank PhRMA for funding the research grant center and for extending complete independence to Altarum to select researchers and specific topics. Altarum and Health Affairs retained all editing rights.

2. An agenda for the webinar that includes full author affiliation information can also be found at this link.