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presentation slides
Sunday, June 25 | Monday, June 26 | Tuesday, June 27
Monday, June 26
8:30 a.m. – 10:00 a.m.
Concurrent Sessions Pay-for-Performance: Perspectives from Around the Globe
Room 606 (level 6)
Chair: Adams Dudley, University of California, San Francisco
Panelists:
Peter Broadhead, Australian Department of Health and Ageing
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May Tsung-Mei Cheng, International Forum, Princeton University
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Anne Frolich, University of Copenhagen, Denmark
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Eric Schneider, Harvard University
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Roundtable: Concerns about quality of care have grown in countries around the world. Strategies to address this have included both clinical projects, such as developing guidelines and quality improvement programs, and efforts to use the financing system to create incentives to improve care. This session will focus on the use of incentives to improve clinical performance. The panel will bring together experts on the implementation and impact of pay-for-performance from Australia, Denmark, Taiwan, and the U.S. Panelists will describe the rationale for different incentive program designs and the effects of pay-for-performance, including both clinical results and the reactions of providers to such incentives.
Technology & Rising Health Care Spending
Room 609 (level 6)
Chair: Harold Luft, University of California, San Francisco
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Panelists: Henry Aaron, The Brookings Institution; Mark Pauly, University of Pennsylvania; Leighton Read, Alloy Ventures; Sean Tunis, HealthTech
Roundtable: Most researchers examining trends in health care expenditures attribute a significant fraction of the rate of growth to technology, rather than to aging and changes in disease prevalence. Although research advances reflect scientific discovery, there are numerous steps from discovery to the development of innovations, their adoption into clinical practice, and the application and widespread use. A more comprehensive understanding of the various steps involved in the process, as well as the nature and extent of various policy levers that might influence the process, can help in projecting, and perhaps altering, the long-term growth in health care spending. Experts from various perspectives will discuss these issues in a roundtable format.
Measuring & Reporting Physician-Level Performance: The Train Has Left the Station, but Where Is it Going?
Room 618-620 (level 6)
Chair: Dana Gelb Safran, Tufts-New England Medical Center
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Panelists:
Melinda Karp, Massachusetts Health Quality Partners
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Elizabeth McGlynn, RAND
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Ted von Glahn, Pacific Business Group on Health
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Methods Workshop: The past five years have seen enormous momentum in the development and use of physician-level performance measures. This session will include discussion of recent advances in this area of measurement as well as numeroeus practical issues confronted as the measures are implemented by initiatives that include pay-for-performance and/or public reporting. The development and implementation of both clinical quality measures and patient care experience measures will be discussed.
Patient Safety in 2006: The Trends & Contributing Factors
Room 4C-4 (level 4)
Chair: Gloria Bazzoli, Virginia Commonwealth University
Panelists:
Ernest Moy, Agency for Healthcare Research and Quality
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Patrick Romano, University of California, Davis
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Sara Singer, Harvard Business School
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Julie Sochalski, University of Pennsylvania
Invited Papers: Concerns about medical errors and patient safety in U.S. hospitals remain substantial despite many private and public sector efforts seeking to address these problems. Hospitals have devoted a great deal of resources to improving patient care, including implementing new information and monitoring systems, computerizing physician orders and patient data, revamping educational training, and implementing clinical protocols. On the payer side, pay-for-performance and quality reporting are both intended to focus increased attention on the problem and motivate organizational change. The invited papers in this session provide an assessment of the current state of our knowledge about patient safety, focusing on the overall trends as well as evidence on disparities among population groups, and also on recent research on the organizational factors that may affect patient safety.
 Medicare Part-D: Successes & Challenges
Room 4C-3 (level 4)
Chair: Scott Young, Agency for Healthcare Research and Quality
Panelists:
Leslie Greenwald, RTI International
“Factors Associated with Regional Variation in Medicare Part D Prescription Drug Plan Participation and Beneficiary Premiums”
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Christopher Roebuck, Caremark
“Dollars to Doughnuts: Predicting Prescription Drug Costs of Beneficiaries and the Medicare Program Under Part D”
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Bruce Stuart, University of Maryland at Baltimore
“Disease Burden and the Intensity of Medication Therapy for Medicare Beneficiaries with Diabetes: Will Part D Make a Difference?”
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James Verdier, Mathematica Policy Research, Inc.
“Prescription Drug Use and Expenditures among Dually Eligible Medicare and Medicaid Beneficiaries in 2001 - Implications for the Medicare Part D Drug Benefit”
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From Evidence to Practice: How to Do It, How to Know if You Succeed
Room 608 (level 6)
Chair: Andrew Nelson, HealthPartners Research Foundation
Panelists:
Lesa Chizawsky, University of Alberta
“The Development of an Instrument to Measure Research Utilization in Health Care Settings and Its Implications for the Knowledge Translation Field”
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Jennifer Leeman, University of North Carolina at Chapel Hill
“Developing a Taxonomy of Methods for Implementing Changes in Nursing Practice”
Julie Lowery, Department of Veterans Affairs, Ann Arbor
“Factors Affecting Compliance with Diabetes Hypertension Guidelines”
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Shannon Scott-Findlay, University of Alberta
“Contextualizing the Findings of a Group Guideline Knowledge Translation Study”
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Cathy Taylor, Vanderbilt University
“Using Crew Resource Management to Improve Diabetes Care and Patient Outcomes in an Inner-City Primary Care Clinic”
Diffusion & Patterns of Medication Use for Mental & Substance Use Disorders
Room 611 (level 6)
Chair: Mady Chalk, Treatment Research Institute
Panelists:
Ayse Akincigil, Rutgers, The State University of New Jersey
“Adherence to Antidepressant Medications among Health Plan Members Diagnosed with Major Depression”
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Susan Busch, Yale University
“The Impact of FDA Regulatory Policy on Depression Treatment for Children and Adolescents”
Marisa Elena Domino, University of North Carolina, Chapel Hill
“Psychotropic Medication Diffusion: State-Level Differences”
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Sharon Reif, Brandeis University
“Coverage and Management of Medications for Treating Substance Abuse in Private Health Plans”
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Cindy Thomas, Brandeis University
“Factors Associated with Adoption of New Medications in Substance Abuse Treatment”
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Older & Sicker: Access & Coverage Issues
Room 612 (level 6)
Chair: Deborah Chollet, Mathematica Policy Research, Inc.
Panelists:
Geoffrey Joyce, RAND
“The Impact of Drug Benefit Caps on Pharmaceutical and Medical Use by the Elderly”
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Rui Li, Centers for Disease Control and Prevention
“Impact of State Mandatory Insurance Coverage on Selected Diabetes Care Services”
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Michael McWilliams, Harvard Medical School
“Medicare to the Rescue: Intensity of Health Services and Costs of Care for Previously Uninsured Adults with Chronic Conditions”
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Karin Nelson, Department of Veterans Affairs & University of Washington
“Veterans Using and Uninsured Veterans Not Using VA Health Care”
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Erin Strumpf, Harvard University
“The Decline in Employer-Sponsored Health Insurance Coverage for Retirees and Its Impact on Older Americans”
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Hospital Quality
Room 607 (level 6)
Chair: Sheldon Greenfield, University of California, Irvine
Panelists:
Hsueh-Fen Chen, Virginia Commonwealth University
“Volume-Outcome Relationships: An Econometric Approach to CABG Surgery”
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Cheryl Fahlman, Center for Studying Health System Change
“A Comparison of Quality of Care in General Hospitals, Specialty Hospitals, and Ambulatory Surgery Centers ”
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Maartje de Vos, National Institute for Public Health and the Environment
“Development and Evaluation of Quality Indicators in the Intensive Care Unit: Preliminary Results”
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Amresh Hanchate, Boston University
“Surgery Volume and Mortality: A Re-examination Using Fixed-Effects Regression”
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Lorraine Mion, MetroHealth Medical Center
“Therapy Disruptions in ICU Settings: Implications for Quality Initiatives”
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Moving Towards a High Performance Health Care System: Opportunities for Cross-National Learning
Room 615-616 (level 6)
Chair: Carolyn Clancy, Agency for Healthcare Research and Quality
Panelists:
Dov Chernichovsky, Ben-Gurion University of the Negev, Israel
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Ashish Jha, Harvard School of Public Health
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Christof Veit, EQS Hamburg, Germany
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pecial Session: This session highlights and compares policy strategies that key industrialized countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Israel, the United Kingdom, and the United States – are undertaking to achieve a high performance health care system, as measured by health, equity and access, cost control, quality and efficiency of care provision, and patient centeredness. A broad overview will look at the performance implications of these nations' respective approaches to the public/private mix of health care financing and provision, competition and consumer choice, regulation and quality control, technology development and adoption, and health manpower development. Health information technology and national hospital quality benchmarking will then be used to provide more specific international examples of policy initiatives that are underpinning countries' efforts to move towards a high performance health care system.
Sponsored by The Commonwealth Fund
Student Poster Panel
Room 604 (level 6)
Chair: Shoou-Yih Daniel Lee, University of North Carolina, Chapel Hill
Panelists:
Winfred Avogo, Arizona State University
Household Structure and Childhood Mortality in Ghana, 1988-2003”
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Andrea Gruneir, Brown University
“Hospitalization of Nursing Home Residents with Cognitive Impairments: Influence of Facility Features and State Policies”
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Rafael Ruiz, University of North Carolina, Chapel Hill
“Cultural and Lifestyle Determinants of Mexican American Adolescents' Risk for Metabolic Syndrome”
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Jean Yoon, University of California, Los Angeles
“Unmet Need for Symptom Management from Breast Cancer Treatment”
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Assessing Quality of Nursing Home Care Using The 2004 National Nursing Home Survey
Room 613-614 (level 6)
Chair: Judith Kasper, Johns Hopkins University
Panelists:
Lisa Dwyer, National Center for Health Statistics
“Medication Practices for the Elderly in U.S. Nursing Homes”
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William Pearson, National Center for Health Statistics
“Electronic Information Systems Use for Patient Care in U.S. Nursing Homes: Data from The 2004 National Nursing Home Survey”
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Robin Remsburg, National Center for Health Statistics
“End of Life Care in Nursing Homes: Skilled Nursing Homes with Special Programs and Trained Staff for Hospice”
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Marie Squillace, U.S. Department of Health and Human Services
“The National Nursing Assistant Survey: A First-Time Direct Care Worker Survey of Certified Nursing Assistants Employed in Nursing Homes”
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Do Consumers Behave Differently in a CDHP?
Room 4C-2 (level 4)
Chair: Judith Hibbard, University of Oregon
Panelists:
Anna Dixon, University of Oregon
“How Does Enrollment in CDHPs Impact on Consumerist Behaviors?”
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Jessica Greene, University of Oregon
“The Influence of CDHPs on Enrollees' Prescription Drug Utilization”
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Judith Hibbard, University of Oregon
“Do CDHPs Stimulate Cost Effective Choices?”
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Ellen Peters, Decision Research
“How Well Do Consumers Understand Their Choice of a CDHP? An Experimental Study”
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10:30 a.m. – 12:00 p.m.
Concurrent Sessions
IOM Report on Crossing the Quality Chasm for Behavioral Health
Room 602-603 (level 6)
Chair:
Mary Jane England, Regis College
Panelists:
Benjamin Druss, Emory University
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Mary Jane England, Regis College
David Gustafson, University of Wisconsin, Madison
Thomas McLellan, Treatment Research Institute
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Michael Zamore, Office of Congressman Patrick Kennedy
Roundtable: Health care for mental and substance-use conditions has a number of distinctive characteristics, such as greater use of coercion into treatment, separate care delivery systems, a less developed quality measurement infrastructure, and a differently structured marketplace. The new IOM report, Improving the Quality of Health Care for Mental and Substance-Use Conditions, examines these differences and finds that the quality chasm framework is applicable to behavioral health and describes a multi-faceted and comprehensive agenda to do so. Panelists will provide an overview of the report, as well as perspectives on how to improve the quality of care for persons with mental and substance-use conditions and achieve better integration with the general health care system. The focus will be on what is actionable now from a policy perspective and what research is still needed to narrow the quality chasm for behavioral health.
Sponsored by the Center for Substance Abuse Treatment
Blue Sky: Expanding Policy Discussions on Health Reform
Room 4C-3 (level 4)
Chair: Neal Halfon, University of California, Los Angeles
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Panelists: Helen DuPlessis; Arleen Leibowitz and Mark Peterson, both from University of California, Los Angeles
Roundtable: Our current level of knowledge about the multiple and interacting factors that influence health status over the course of a lifetime, and the empirical data about the effectiveness of health promotion, disease prevention, and social and environmental interventions in altering an individual's health trajectory, argue for a health system that rebalances the allocation of resources across medical, public health, population, and civic sectors. Still the prevailing analysis of the failing U.S. health system focuses on coverage, quality, cost, and disparities – issues that address problems inherent to only the medical care system – leading to piecemeal policy solutions that are incapable of addressing the systemic forces we know shape the health status of individuals and populations. This roundtable will provide a framework and set of principles aimed at transformative reform of the American health and health care system and examples of innovative and effective programs consistent with those principles and concepts. Panelists and participants will be invited to think beyond the traditional policy and system consideration that typically constrain their deliberations and move from incremental to transformative solutions to our health system crisis.
Efforts to Reduce Disparities: Barriers, Innovation, Implementation & Evaluation
Room 4C-4 (level 4)
Chair: David Nerenz, Henry Ford Health System
Panelists:
Anne Beal, The Commonwealth Fund
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Joseph Betancourt, Massachusetts General Hospital
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Marshall Chin, University of Chicago
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Lisa Cooper, Johns Hopkins University
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Constance Martin, Center for Health Care Strategies, Inc.
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Roundtable: Racial/ethnic disparities in health care have been well-documented, but we know much less about what can be done to reduce or eliminate those disparities. The roundtable discussion will include examples of successful initiatives, discussion of how challenges of implementation and evaluation have been met, and discussion of how information on successful initiatives is being collected and disseminated. General discussion at the end of the session will focus on how the perspectives of health services research, quality improvement, and program evaluation can be blended to create a useful body of knowledge about efforts to reduce or eliminate disparities.
Costs & Quality: A Twisted Relationship
Room 609 (level 6)
Chair: Gregory Pawlson, National Committee for Quality Assurance
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Panelists:
Derek Feeley, NHS Scotland
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Elliott Fisher, Dartmouth Medical School
David Hopkins, Pacific Business Group on Health
Sarah Hudson Scholle, National Committee for Quality Assurance
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Robert Weech-Maldonado, Department of Veterans Affairs & University of Florida
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Roundtable: Both cost and quality are major concerns in health care systems in the U.S. and elsewhere. While there is a growing literature concerning the relationship between cost and quality in some settings, there is much we do not understand about how quality affects cost, and vice versa, in different sectors of our health care system. The presentations and discussions will be led by active researchers in this area, beginning with a review of current findings and major methodological challenges and proceeding to identification of areas that are most critical for future study. Active audience input will be encouraged.
Sponsored in part by the Mayo Clinic, Division of Health Care Policy & Research
Innovations in Coordinating Care in Disease Management
Room 608 (level 6)
Chair: Edward Wagner, Group Health Cooperative
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Panelists:
Gerard Anderson, Johns Hopkins University
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Eric Coleman, University of Colorado Health Sciences Center
John Neff, Children's Hospital, Seattle
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Roundtable: Inadequate communication among the various providers and institutions providing care for a chronically ill adult or child continues to be a source of danger and frustration for patients and families, and excess costs to purchasers. This session will describe innovations in coordinating care for the chronically ill across the lifespan. The innovations described will consider the roles of enhanced information technology, nurse care managers, and the redesign of primary care. The panel will consider the implications of a growing chronically ill population and increasing care complexity on the future of primary care.
Advances in Qualitative Methods in Health Services Research
Room 4C-2 (level 4)
Chair: Kelly Devers, Virginia Commonwealth University
Panelists:
Kristin Carman, American Institutes for Research
Daniel Dohan, University of California, San Francisco
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Sally Thorne, University of British Columbia
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Methods Workshop: The general purpose of this session is to examine some of the methodological challenges encountered when using qualitative methods to conduct research in our field, possible ways to address these challenges, and the implications for researchers, funders, and policymakers. This year, the panel examines two specific methods, focus groups and participant observation/ethnography, and the broader issue of whether findings from qualitative studies should and could be synthesized, and if so, how (i.e., qualitative meta-synthesis and the role of qualitative studies in an era of evidence based practice).
Enhancing Validity of Physicians' Economic Profiles
Room 618-620 (level 6)
Chair: William Thomas, University of Southern Maine
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Panelist: Niall Brennan, Medicare Payment Advisory Commission
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Methods Workshop: This session will deal with methodologies for analyzing claims databases to produce measures of physician cost efficiency. The speakers will differentiate between primary care physician (PCP) profiling, which utilizes person-level risk adjusters to estimate patients' expected costs, and specialty physician profiling, which utilizes episode grouper software to define chronologically and diagnostically homogeneous episodes of care. Assumptions underlying each of the two profiling approaches will be reviewed, and key methodological issues will be identified, including, for episode based profiling, treatment of cost outlier episodes, episode attribution rules, minimum episode sample sizes, and cost efficiency metrics. Results of a just completed MedPAC study that examines characteristics of the two most widely utilized episode grouper software packages will be described, other current research findings will be presented, and important research questions that remain unaddressed will be identified.
Provider & Organizational Responses to Payment & Policy Changes
Room 606 (level 6)
Chair: Stephen Mick, Virginia Commonwealth University
Panelists:
Andrew Epstein, Yale University
“Within Hospital Payer and Race Differences in the Early Use of Drug-Eluting Coronary Stents”
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Daniel Harris, CNA Corporation
“A Linear Programming Approach to Optimizing the Distribution of Health Care Providers across a Multi-Site Staff Model Managed Care System”
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Jonathan Ketcham, Arizona State University
“Physician-Hospital Gainsharing: Evidence from Early Adopters' Experience in Cardiology”
Eric Seiber, Clemson University
“Physician Billing Behavior in Two State Programs”
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Pamela Spain, University of North Carolina, Chapel Hill
“Organizational Factors Related to Hospital Organ Donation Rates”
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Clinical Health IT in Hospitals & Ambulatory Settings (Including E-Prescribing)
Room 612 (level 6)
Chair: Christine Elnitsky, Department of Veterans Affairs, Washington, D.C.
Panelists:
Nance Goldstein, Brandeis University
“The Promise of Clinical IT Systems? Implications for Practice from Qualitative Research”
Joy Grossman, Center for Studying Health System Change
“Physicians' Use of E-Prescribing Systems in Today's Market”
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Douglas Johnston, New England Healthcare Institute
“Case Statement for Implementation of CPOE in all Massachusetts Hospitals”
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Jodi Simon, University of California, Berkeley
“Physician Organizations' Use of Clinical Decision Support for Order Entry”
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Christine Vogeli, Massachusetts General Hospital
“Adoption of Electronic Prescribing in Community-Based Medical Practices”
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Medicare: Impact of Different Payment & Coverage Policies on Utilization & Outcomes
Room 604 (level 6)
Chair: Scott Young, Agency for Healthcare Research and Quality
Panelists:
Brian Biles, George Washington University
“Medicare Advantage Plans: Different Payments, Different Benefits”
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Susan Bartlett Foote, University of Minnesota
“Do Medicare Coverage Policies Matter? Evaluating the Impact of Coverage Policies on Utilization of Services”
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Walid Gellad, Brigham and Women's Hospital
“Race and Non-Adherence to Prescription Medications among Seniors: Results of a National Survey”
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Rebecca Lewis, American College of Radiology
“Effect of Physician Referral Patterns on Medicare Utilization of Diagnostic Imaging”
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Ilene Zuckerman, University of Maryland at Baltimore
“Drug Use in Severely Mentally Ill Medicare Beneficiaries: Impact of Discontinuities in Drug Coverage”
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Demystifying the Federal Grant Review Process
Room 607 (level 6)
Chair: Ming Tai-Seale, Texas A&M University Health Sciences Center
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Panelists:
Francis Chesley, Agency for Healthcare Research and Quality
Enola Proctor, Washington University
Kenneth Wells, University of California, Los Angeles
Skill and Career Development: The federal grant proposal review process could appear mysterious or rather daunting to fledgling grant applicants. This panel includes AHRQ's Director for Extramural Research, Training, and Vulnerable Populations and three health services researchers with career orientations in health economics, medicine, and social work. The panel aims to facilitate a better understanding of the federal grant review process among participants. The panelists' serve both in the federal government and on review committees (e.g., NIH and AHRQ). Their own grant-making experience will provide participants a wide range of perspectives and rich grounds for interaction. Discussion topics will include, but not limited to: 1) communicating your research plan to reviewers, especially those who may not speak your technical language; 2) using the Summary Statement to help you revise and resubmit a proposal; 3) understanding the roles of federal program and review staff; and 4) the implementation of electronic grant application.
Innovations from Abroad: Spotlight on Policy & Practice
Room 615-616 (level 6)
Chair: Robin Osborn, The Commonwealth Fund
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Panelists:
Marie Bismark, Buddle Findlay, New Zealand
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Steven Morgan, University of British Columbia
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Daniel Timothy Wilson, Pricewaterhouse Coopers, LLP, London
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Special Session: Findings from The Commonwealth Fund's 2005 International Health Policy Survey of Sicker Adults will compare the experiences of patients in six countries with access, choice, pharmaceuticals, medical errors, coordination of care, and management of chronic illnesses. Reflecting those themes and country efforts to move towards high performance health care systems, examples of international innovations in policy and practice will be examined, including: New Zealand's no fault medical malpractice system approach to monetary and non-monetary compensation; centralized drug review processes established in Australia, Canada, New Zealand and the United Kingdom to use evidence to inform drug coverage decisions and policy; and, a broad reform agenda in the United Kingdom that includes pay-for-performance, a National Patient Safety Agency, the National Institute for Clinical Excellence, and the introduction of market forces.
Sponsored by The Commonwealth Fund
Impact of Pay-for-Performance Programs on Quality and Costs of Health Care: Lessons from Massachusetts, New York, & California
Room 611 (level 6)
Chair: Eric Schneider, Harvard University
Panelists:
Howard Beckman, Rochester Individual Practice Association
“Can Underuse Measures Reduce Cost? The ROI for Diabetes and Coronary Artery Disease”
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Cheryl Damberg, RAND
“Rewarding Performance: Two-Year Results from California 's Statewide Pay-for-Performance Experiment”
Steven Pearson, National Institute for Health
“Performance of Physician Groups after Pay-for-Performance: Natural Experiment in Massachusetts”
PowerPoint Slides | PDF Handout of Slides
Managing Chronic Disease in the VA Integrated Health System
Room 613-614 (level 6)
Chair: Stephan Fihn, Department of Veterans Affairs, Seattle
Panelists:
Michael Ho, Department of Veterans Affairs, Denver
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Linda Kinsinger, Department of Veterans Affairs, National Center for Health Promotion
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Polly Hitchcock Noel, Department of Veterans Affairs, San Antonio
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Leonard Pogach, Department of Veterans Affairs, East Orange, NJ
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Research Update: As the largest integrated health system in the U.S., the Department of Veterans Affairs (VA) offers a unique laboratory for understanding the factors that foster effective care coordination and chronic disease management in clinical practice. Care coordination in the VA is the application of care and case management principles to the delivery of health care services using health informatics, telehealth technologies, and evidence based strategies. The objective of this session is to share recent innovative strategies in the care of patients with complex and multiple comorbidities.
Sponsored by the Department of Veterans Affairs
12:00 p.m. – 7:00 p.m.
Exhibits Open 12:15 p.m. – 1:45 p.m.
Luncheon Plenary
Room 6 A/B/C (level 6)
Distinguished Investigator Award Presentation
Awardee: Karen Davis, The Commonwealth Fund
Presenter: Dorothy Rice, University of California, San Francisco
AcademyHealth Chair Address and Award
The Ownership Society & Health
Thomas Rice
University of California, Los Angeles
Awardee: John Iglehart, Health Affairs
2:00 p.m. – 3:30 p.m.
Concurrent Sessions
The Revolution in Payment Models for Chronic Care
Room 4C-4 (level 4)
Chair: Louis Rossiter, College of William & Mary
Panelists:
Stephan Fihn, Department of Veterans Affairs, Seattle
PowerPoint Slides | PDF Handout of Slides
Richard Kronick, University of California, San Diego
Linda Magno, Centers for Medicare and Medicaid Services
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Roundtable: Health care costs for chronic diseases are skyrocketing. At an estimated 56 percent of total health spending, chronic care costs can only increase as a share of spending when the boomer population ages into Medicare. A quiet revolution has been taking shape in the last few years as the Veterans Health Administration, private insurers, state Medicaid programs; and, now, even Medicare have instituted, implemented or experimented with totally new payment models for chronic care. Recognizing that visit or episode-based fee for service has few incentives for coordination of largely predictable costs and patterns of care, new models are changing the way things are done. This session will hear how the Medicare experiments in chronic care improvement are progressing, what we know from the experience for veterans, and how an ever larger number of states are making risk-adjusted payments for chronic care patients.
Challenges & the Politics of Counting the Uninsured
Room 4C-3 (level 4)
Chair: Michael Davern, University of Minnesota
Panelists: Joseph Antos, American Enterprise Institute; Sherry Glied, Columbia University; John Holahan, The Urban Institute; Christine Hulet, Washington State Office of the Governor; Mark Rupp, Washington State Office of the Governor
Roundtable: Counting the uninsured is a critical component of state and national coverage initiatives. The estimate of the number of uninsured and their characteristics is used to (1) identify the scope of the problem, (2) target scarce resources to those at greatest risk or need, (3) evaluate the impact of public program expansions, (4) evaluate crowd out of private health insurance coverage, and (5) monitor trends in public and private coverage. Depending on how a person counts the uninsured, and what data source is used, very different conclusions can be drawn. The expert panel will discuss how counting the uninsured often creates political controversy.
Health Information Technology & Return on Investment: Fact or Fantasy?
Room 615-616 (level 6)
Chair: Murray Ross, Kaiser Permanente Institute for Health Policy
Panelists:
Douglas Conrad, University of Washington
Molly Coye, Health Technology Center
Ashish Jha, Harvard School of Public Health
Louise Liang, Kaiser Foundation Health Plan, Inc.
Roundtable: The significant upfront investment required is the single largest obstacle facing health systems in adopting health information technology. The payback on these investments is a long-term proposition and much of the benefit accrues to patients and others. This session will examine the business case for HIT, what factors are critical for ensuring success, and the role for public policy.
New Methods in Measuring Health Disparities
Room 618-620 (level 6)
Chair: Linda Bilheimer, National Center for Health Statistics
Panelists:
Allen Fremont, RAND
PowerPoint Slides | PDF Handout of Slides
Richard Klein, National Center for Health Statistics
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Elsie Pamuk, National Center for Health Statistics
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Methods Workshop: This workshop will discuss a range of methodological questions that arise in the measurement of health disparities. How researchers address those questions has important implications for estimates of the magnitude of disparities among different racial/ethnic and socioeconomic subgroups, and how those disparities are changing over time. Panelists will provide an overview of some of the basic measurement issues and discuss the approaches used to monitor the Healthy People 2010 goal to eliminate disparities. They will also focus on a particular methodological issue: the development of summary measures of disparity when the domains of interest comprise ordered categories (such as income or education). Finally, we will discuss how to use geocoding and surname analysis to develop indirect measures of both racial/ethnic and socioeconomic disparities and help target interventions to reduce disparities.
Assessing Performance at Different Levels of the Health Care System: Issues & Answers
Room 4C-2 (level 4)
Chair: Sherrie Kaplan, University of California, Irvine
Panelists:
Sheldon Greenfield, University of California, Irvine
PowerPoint Slides | PDF Handout of Slides
Dana Mukamel, University of California, Irvine
Rebecca Lipner, American Board of Internal Medicine
PowerPoint Slides | PDF Handout of Slides
Sharon-Lise Normand, Harvard Medical School
PowerPoint Slides | PDF Handout of Slides
Joachim Roski, National Committee for Quality Assurance
Methods Workshop: The proliferation of profiling and pay-for-performance initiatives targeting various levels of the health care system, from institutions to individual providers, has heightened the need to identify and resolve some of the complex methodological challenges that attend performance assessment. This session will focus on specifying the nature of these challenges, including selection of appropriate quality measures to reflect performance of the profiling target; methods for and appropriateness of creation of composite measures; the role of case-mix adjustment in profiling; sampling, power and nesting in performance profiles; assessing reliability and validity of profile scores; and statistical issues related to the creation and interpretation of performance profiles. Panelists will present potential solutions to these challenges.
Innovations & Transformation in Mental Health Financing
Room 606 (level 6)
Chair: Richard Scheffler, University of California, Berkeley
Panelists:
PowerPoint Slides | PDF Handout of Slides
Timothy Brown, University of California, Berkeley
Judy Hall, Washington Department of Social and Health Services
David Pollack, Oregon Department of Human Services
PowerPoint Slides | PDF Handout of Slides
Leslie Tremaine, New Mexico Behavioral Health Collaborative
Invited Papers: The President's New Freedom Commission on Mental Health Report in 2003 recommends transforming the mental health system to reflect that recovery from mental illness is a real possibility and suggests a number of solutions to reach a transformed system. This session will report on the various innovations and strategies chosen by four states, California, Washington, Oregon, and New Mexico, to transform the mental health system with the goal of ensuring transformation. This session will focus on the innovative strategies, including financing, that is required for system change.
Expanding the Home Care Workforce: National & Global Perspectives
Room 607 (level 6)
Chair: Debra Lipson, Mathematica Policy Research, Inc.
Panelists:
Randall Brown, Mathematica Policy Research, Inc.
PowerPoint Slides
Candace Howes, Connecticut College
PowerPoint Slides
Giovanni Lamura, Italian National Research Centre on Ageing
PowerPoint Slides
Robyn Stone, American Association of Homes and Services for the Aging
Invited Papers: As national and state governments seek to create sustainable systems for providing long-term care to a rapidly aging population, they face an enormous challenge – finding and keeping enough home care workers to meet increased demand. This session features three invited papers from researchers in the U.S. and Italy on strategies for expanding the home care workforce. The papers assess the impact on the home care workforce when consumers have more choice in hiring, examine the effect of higher wages and health insurance benefits on attracting and retaining home care aides, and explore the roles of family caregivers, informal migrant labor, and formal agency-hired home care aides in expanding the overall supply of home care workers. Discussion will identify policy implications and key research questions for the future.
Quality: Coordination & Transitions
Room 609 (level 6)
Chair: Gregory Pawlson, National Committee for Quality Assurance
PowerPoint Slides | PDF Handout of Slides
Panelists:
Christina Bethell, Oregon Health and Science University
“Measuring Coordination of Care for Children with Special Health Care Needs: Alternative Methods and Findings in National and State Level Surveys”
Denise Hynes, Department of Veterans Affairs, Hines, IL
“Cost-Effectiveness of Hernia Surgery: Implications for Practice”
PowerPoint Slides | PDF Handout of Slides
Hector Pelayo Rodriguez, Tufts-NEMC
“Primary Care Teams: Effects on the Quality of Clinician-Patient Interactions and Patients' Primary Care Experiences”
PowerPoint Slides | PDF Handout of Slides
Jean Ann Seago, University of California, San Francisco
“Nursing Characteristics and Patient Outcomes: A Multi-Level Model”
PowerPoint Slides | PDF Handout of Slides
Amy Smalarz, Department of Veterans Affairs & Brandeis University
“Successful Governing Models for Physician Groups Leading to Improved Quality Performance”
PowerPoint Slides | PDF Handout of Slides
Public Reporting & Pay-for-Performance: Practical Challenges
Room 608 (level 6)
Chair: R. Adams Dudley, University of California, San Francisco
Panelists:
Gestur Davidson, University of Minnesota
“Implications of Hospital Size for Uncertainty about "True" Performance Rankings in a Hospital Pay-for-Performance Program: Lessons from the Premier Hospital Quality Project”
PowerPoint Slides | PDF Handout of Slides
Mingshan Lu, University of Calgary
“Financial Incentives and Gaming in Alcohol Treatment”
Stephen Persell, Northwestern University
“Measuring Outpatient Coronary Artery Disease Quality of Care Using Electronic Health Records: Pitfalls and Targets for Improvement”
PowerPoint Slides | PDF Handout of Slides
Hoangmai Pham, Center for Studying Health System Change
“How Many Doctors Does It Take to Treat a Patient? The Challenges that Fragmented Care Poses for Pay-for-Performance”
Rachel Werner, Department of Veterans Affairs & University of Pennsylvania
“The Relationship between Performance on Quality Indicators and Mortality Rates: Results from Medicare's Hospital Compare Report Card”
PowerPoint Slides | PDF Handout of Slides
Beyond the Numbers: Innovations in National & International Health Workforce Research
Room 612 (level 6)
Chair: Chapin White, Congressional Budget Office
Panelists:
Onyebuchi Arah, University of Amsterdam
“Physician Migration to the United States, Canada, United Kingdom and Australia: Profiling the Source Countries”
PowerPoint Slides | PDF Handout of Slides
Chiu-Fang Chou, University of Illinois
“Determinants of First Practice Location Choice by New Physicians”
PowerPoint Slides | PDF Handout of Slides
Tracy Finlayson, University of California, Berkeley
“An Economic Analysis of the Labor Market for Dental Hygienists and Dental Assistants in California: 1997-2005”
PowerPoint Slides | PDF Handout of Slides
Somnath Saha, Department of Veterans Affairs & Oregon Health and Science University
“The Evidence Base for Diversity in the Health Professions”
PowerPoint Slides | PDF Handout of Slides
Training Health Services Researchers for the 21st Century
Room 602-603 (level 6)
Chair: Stephen Shortell, University of California, Berkeley
Panelists:
Jeffrey Alexander, University of Michigan
Christopher Forrest, Johns Hopkins University
PowerPoint Slides | PDF Handout of Slides
Diane Martin, University of Washington
Sam Sheps, University of British Columbia
Special Session: Health services research has been developing for the past 40 years, and given this maturity and established professional identity, it is now appropriate to propose common competencies for professionals in the field. This session will present the results of a consensus process that led to the development of 14 core competencies for doctoral health services research education. A panel of national experts in HSR doctoral education will offer perspectives on the core competencies. The session is intended to foster discussion among attendees on the scope of the competencies, how to integrate them into doctoral training, and ideas for next steps for further discussion on HSR education.
Predicting Consumer Responses to New Types of Health Plans
Room 613-614 (level 6)
Chair: Sharon Arnold, AcademyHealth
Panelists:
Austin Frakt, Department of Veterans Affairs & Boston University School of Public Health
“The New Medicare Prescription Drug Plans: Availability, Costs, and Benefits”
PowerPoint Slides | PDF Handout of Slides
Stephen Parente, University of Minnesota
“Health Insurance Demand Responses from New Price Structures Offered by Consumer Directed Health Plans”
PowerPoint Slides | PDF Handout of Slides
Steven Pizer, Department of Veterans Affairs & Boston University
“Storm Clouds on the Horizon? Predicting Adverse Selection in Medicare Prescription Drug Plans”
PowerPoint Slides | PDF Handout of Slides
The Genomics Revolution: Challenges in Translating New Drugs & Diagnostics into Practice & Policy
Room 611 (level 6)
Chair: Kathryn Phillips, University of California, San Francisco
Panelists:
Katrina Armstrong, Department of Veterans Affairs & University of Pennsylvania
“Moving Forward on Evidence Based Assessment of Genomic Applications: The EGAPP Project”
PowerPoint Slides | PDF Handout of Slides
Jennifer Haas, Brigham and Women's Hospital
“High Cost, Low Coverage Drugs: Expenditures and Medicare Formulary Coverage for Biotechnology Drugs”
PowerPoint Slides | PDF Handout of Slides
Patricia Keenan, Harvard University
“Medicare and New Technology”
PowerPoint Slides | PDF Handout of Slides
Kathryn Phillips, University of California, San Francisco
“The Paradigm Shift of Personalized Medicine: Economic and Policy Challenges”
PowerPoint Slides | PDF Handout of Slides
SAMHSA Research Update: Scrutiny of Care for Children & Adolescents with Mental & Substance Use Disorders through Analysis of National Databases
Room 604 (level 6)
Chairs:
Jeffrey Buck, Center for Mental Health Services
PowerPoint Slides | PDF Handout of Slides
Sarah Wattenberg, Center for Substance Abuse Treatment
Panelists:
Rosanna Coffey, Medstat
PowerPoint Slides | PDF Handout of Slides
Tami Mark, Medstat
PowerPoint Slides | PDF Handout of Slides
Research Update: As the completeness and quantity of federal databases enlarges, the ability of researchers to identify specialty mental health services and substance abuse treatment advances dramatically. This SAMHSA session will depict new endeavors exploiting existing databases to examine the cost, utilization and quality of care to children and adolescents with mental and substance use disorders. Challenges, techniques and findings will be discussed from a number of databases, including the Centers for Medic | 
