Health Wonk Review: Research Edition

24 Jun

The Annual Research Meeting for AcademyHealth kicks off this weekend in Boston–starting with interest group meetings on Saturday and continuing with the presentation of a variety of workshops, presentations, and round table discussions through Tuesday. It’s a great chance for members of the health policy and health services research communities to get together and learn from each other by sharing their work. In that spirit, I present the Research Edition of the Health Wonk Review–a chance for you to learn from the best recent work of the health policy bloggers. (As an aside, I’ll be in town for the AcademyHealth meeting, and encourage you to get in touch with me if you’ll be there too and would like to meet up.)

Why is research so important? Well, obviously, both sides in the fight over health reform used research–of some kind–to support their respective positions. More than that, however, research is going to prove incredibly important going forward as health reform is implemented and evaluated. After all, if we don’t evaluate it, how will we know if it’s working as intended and how will we know what further changes need to be made?

While a lot of health policy and health services research is currently underway, it’s a bit too soon to evaluate health reform, or is it? In what is essentially qualitative research, Henry Stern of The InsureBlog does a nice bit of investigative reporting into insurance company nHealth’s claim that they are being forced to go out of business as a consequence of “ObamaCare.” Stern, a self-proclaimed opponent of the reform law, wishes this were true, but finds that nHealth’s claim is likely dubious. Although, if not, he says, we will continue to see more such closures in short order.

John Goodman, President of the National Center for Policy Analysis, chimes in as well with some pretty grim predictions about the implications of health reform. According to Goodman, “ObamaCare” will break most of its promises, including the all-important “If you like your coverage you can keep it.” It’s important to keep in mind, however, that both of these posts are reporting on forecasts–they’re prospective rather than retrospective–so their predictions may or may not be borne out.

Still, it’s an election year, seniors tend to vote in greater numbers than other groups, and they are none-too-pleased about the prospects of cuts to the Medicare program, writes Austin Frakt of The Incidental Economist. So, to recap, government involvement in health reform could be quite bad–especially if it places limits on health insurance financed by the federal government. Paradoxes make for great research.

Anyway, accepting that this health reform is less than perfect, one has to wonder how bad “ObamaCare” will really be if it mirrors other forms of “socialized medicine” like the Veterans Administration health system. This is an example of extrapolating the findings from one setting in order to generalize and make predictions about the outcomes in another area. Over at Managed Care Matters, Joe Paduda covers this topic by looking at a recent report from the Congressional Budget Office that finds that the VA health system has done a wonderful job of controlling costs while providing exceptionally high quality care. In fact, it makes private insurance look downright bad. So, maybe a single-payer system might be a good thing. Maybe this explains the Colorado Health Insurance Insider’s post from Louise that presents the case that Barbara Bush believes health insurance to be a right. A Republican believes health insurance is a right? Is this pseudoscience or are we witnessing a paradigm shift?

But enough about health insurers, what about health care providers? Well, for starters, Rich Elmore at Healthcare Technology News cites the results of a national Gallup poll of physicians that puts the cost of practicing defensive medicine at 26% of total health care costs–between $650 billion and $800 billion. Now, there are methodological concerns with relying too heavily on self-reported data from physicians whose responses may suffer from things like recall bias, but there’s also something to be said for asking physicians themselves about how they practice medicine. Even if they are over-reporting their numbers by half, we could still save nearly $400 billion by finding a way to eliminate the practice of defensive medicine.

Next, Richard Fogoros (aka DrRich) of the Covert Rationing Blog takes a fascinating look at physician-industry relationships and advocates for them and the benefits they can yield, despite the potential for conflicts of interest to arise and the threats they pose.

Bringing it all together–insurers, providers, and patients–Jaan Sidorov of the Disease Management Care Blog checks out a press release from Blue Cross Blue Shield of Michigan and scrutinizes the possible–repeat possible–likelihood that the Patient Centered Medical Home could reduce insurance claims expense. While the PCMH has yet to show credible savings outside of Medicaid or integrated delivery systems, the potential promise of the model has led to its inclusion in the new health reform law. The jury is still out, but based on BCBSM, maybe there is a reason to be optimistic about the PCMH.

There is certainly a need for a better integrated delivery system. At “health AGEnda”–the blog of the John A. Hartford Foundation–Chris Langston looks at the issue of transitioning older adults from the hospital to other settings like home health care and rehabilitation facilities as well as who is providing patients’ care in the hospital and asks if we’re “Fumbling the handoff?” The interesting thing here, in my opinion, is that people seem very “anti-hospitalist.” Langston highlights this to point out the need for more interdisciplinary teams in medicine, and while I agree, I also see it as underscoring the need for more consumer involvement in the health care system. And that’s exactly what the Health Care Renewal Blog’s Roy Poses advocates in his post “Finding Out About Healthcare Bureaucracy the Hard Way.”

All of these changes could be facilitated by the implementation of health IT, but overcoming the status quo will require a significant investment of time, money, and energy. At the Healthcare Talent Transformation blog, Peggy Salvatore writes about the intersection of health reform, health IT, and reimbursement cuts–making it clear that health IT is the future of health care, but also underscoring that its advent will be a painful transition for many who are already feeling the pinch.

One of the biggest questions in all of this is: Will the Patient Protection and Affordable Care Act actually be able to bend the cost curve? The June issue of Health Affairs tackles this and other aspects of health reform, and Chris Fleming presents a nice synopsis on the Health Affairs Blog. Another big question is how health reform will encourage more comparative effectiveness studies. This is about which treatment works better–but it also has the potential to open the door to cost-savings if we decide to stop covering certain treatments based on cost-effectiveness analysis. David Williams of the Health Business Blog takes a look at some of the barriers to comparative effectiveness research through the unique lens of a JAMA study of two nearly equivalent drugs: Avastin and Lucentis.

And what do we do when some of the elements of health reform inevitably don’t work out? Well, we could start by looking at how they do things elsewhere, and thinking about which elements we might be able to borrow. For that, we can look to a recent series exploring a variety of international health care systems posted by Jason Shafrin at The Health Economist. Jason covers the usual suspects (e.g., France and Canada) as well as some interesting and often overlooked countries (e.g., Japan and Rwanda).

Not everyone who submitted for this edition had a research-related post to offer, but they deserved to be included nonetheless. In a two-part post, Jon Coppelman of Workers’ Comp Insider tells the sorry tale of New York’s self-insured trusts for workers comp (part 2 here), a case of joint and several liability run amuck.

Next Up: Health Wonk Review takes a well-deserved break for summer vacation and comes back on July 22nd, with an edition hosted by Julie Ferguson at the Worker’s Comp Insider.


Posted by on June 24, 2010 in Uncategorized


4 responses to “Health Wonk Review: Research Edition

  1. Henry Stern, LUTCF, CBC

    June 24, 2010 at 1:51 pm

    Brad – What an OUTSTANDING job!! Well laid out, clever, just really top-notch!Thank you so much for hosting, and for including our post.

  2. Jonena Relth

    June 24, 2010 at 2:45 pm

    Brad,Great article to finsh out Health Wonk Review before the break. Enjoy your vacation! I'm looking forward to future posts after your return.Jonena

  3. Evelyn

    June 25, 2010 at 12:50 pm

    What are the initial changes Americans will experience in the new Health Care bill?


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