Tuesday morning came early for attendees, whose minds were still reeling from the great debate and discussions from the preceding ‘day one’ of the 2015 National Health Policy Conference. Day two of the conference was filled with sessions covering everything from state health, payment reform, and market pressures to knowledge translation “straight talk” on policy and politics.
The following are brief session highlights from AcademyHealth staff:
Success Stories in Translating and Disseminating Research
“There’s a lot of great health services research and a lot of knowledge about how to communicate it effectively. Our job is to bring those worlds closer together,” said Translation and Communications Interest Group (IG) Chair and session moderator Wendy Opsahl, Ph.D., in her opening remarks of this joint IG breakfast. This session brought together two researchers—at different stages in careers and with varying degrees of public interest in their respective research topics—who have had success translating and disseminating research, providing critical perspectives for attendees in different phases of their research.
On the one hand was Nathan Hale, Ph.D., an earlier-career researcher with a focus on public and population health. On the other hand was Sharon Long, Ph.D., a tenured professor and recipient of the 2012 HSR Impact Award, whose work on evaluating the impacts of health reform in Massachusetts gained national coverage. Hale, like many, took the traditional dissemination avenues taught to students, including submitting manuscripts to conferences, but felt his work truly began gaining recognition after being matched with a mentor who was able to help him with his approach to translation and communication. “It takes someone with a different set of skills to take what you’re doing and make it more approachable,” said Hale. “I incorporate that into everything I do now.”
Dr. Long said she was fortunate in her work because there was interest at the state and national level. For that reason, a focus for her and her team in the first year was developing a strategy to provide tailored information to interested stakeholders. Although they wanted the peer review component to establish credibility of the research and its methodology, her team knew the audiences they need to reach, provided a forum for them to interact, and was part of a coordinated effort to reach out to those constituencies.
Hale, Long, and discussant Leighton Ku, Ph.D., M.P.H., left attendees with valuable nuggets of information: don’t underestimate the value of allies and partners to extend your message; consider alternate vehicles, such as blogs and webinars, to promote your work; write with an eye for knowing how you would communicate information; and work with policymakers early to improve likelihood of research’s policy relevance.
Capitol Hill Alumni Plenary
The congressional panel is always a favorite, and this year’s session made up of Capitol Hill alumni was no exception. Three former congressional staffers—Dan Elling, Erik Fatemi, and Cheryl Jaeger—provided insights from years spent on the Hill, making them highly qualified to provide insight into the coming year’s most pressing policy issues. All noted steady shifts from the beginning of their careers in politics to the present, particularly in the composition of parties and the shrinking of the ideological 'middle.'
When discussing what is to come, the former staffers made a number of forecasts and told people where to pay attention:
- All roads point to another six- to nine- month patch for the Medicare Sustainable Growth Rate, predicted Elling. This legislation will tee up nicely with reauthorization, he said, creating a perfect storm for legislation in the fall that includes the debt ceiling and budget reconciliation.
- Fatemi said to pay attention to Department of Homeland Security appropriations as an indicator for how Congress might function this year. Although people are beginning to consider fiscal year (FY) 2016 funding, Congress has yet to figure out FY15. There has been some talk of raising defense spending at the expense of non-defense discretionary funding, which includes health, but for the time being—as long as there’s a President in office who would veto such a measure—he foresees the status quo for health remaining primarily intact.
- Congress may also expect more votes on bills that aim to tweak components of the ACA, Jaeger said. The Senate has not had the opportunity to debate fundamental changes to the law, and lawmakers want to make the opinions of new members in both the House and Senate known.
- The King v Burwell Supreme Court case will also be critical in 2015. Jaeger recognized that both bodies need to be prepared with solutions, for it will enact a major shift in how subsidies are delivered.
Late-Breaking Session: Studying Implementation of the ACA in 36 States
States’ Affordable Care Act exchange implementations have had varying degrees of success. During this session, Michael Sparer, Carol Weissert and Mark Hall briefed attendees on the state of exchanges in Connecticut, Florida, and New York and Massachusetts, respectively.
Connecticut, arguably the most successful of the three exchanges, was eager to set up its exchange and one of the first to do so. It’s one of the top-performing exchanges in the country. Hall says part of the reason for the state exchange’s success is its quasi-governance model, where various governmental officials represent various areas of expertise. Florida’s exchange has signed up 1.3 million people despite working against a legislature attempting to hinder its success. Weissert believes that progress is due to well-organized and energized groups, which fought the state’s intransigence. New York and Massachusetts also had drastically different outcomes. New York was relatively successful with a robust market, one of the most competitive exchanges in the country, and Massachusetts, which was believed would be highly successful given its past, was a “fiasco,” as Sparer described, resulting from flawed technologies, among other factors.
These exchanges are now embarking in phase two of the work—multi-state, cross-sectional reports that will compare aspects of the exchanges most important to the American public. These longitudinal studies will compare everything from marketplace competition to technology and outreach.
Lunch Plenary: Federalism in the Era of the ACA
In Tuesday’s lunch plenary “Federalism in the Era of the ACA” the dynamic duo of Alice Rivlin and Dick Nathan shared perspectives on the role of federalism in health policy, particularly in the period following the passage of the Affordable Care Act (ACA). Dr. Joe Thompson, Arkansas Center for Health Improvement, who moderated the panel, set the stage with a reminder that the authors of the constitution gave states all responsibilities not explicitly granted to the federal government.
The session drew upon both the tremendous experience of its panelists and their recent collaboration to develop a network of field researchers to expand the knowledge base of understanding around state implementation of the ACA and demonstrate that a spirit of continuous improvement can reinvigorate management at all levels of our system.
In her remarks, Dr. Rivlin made three points. First, she outlined her belief that the ACA was the right legislation at the right time, and that it is here to stay. Second, she reiterated that the ACA is a huge experiment giving states major roles – necessarily and appropriately in her view – to shape their programs in response to their needs. Finally, she noted that implementation is the most important part of policymaking, despite being the phase on which the United States has historically performed weakest.
Dr. Nathan then contributed perspective on how the network of field researchers in 36 states had begun to capitalize on the opportunity and challenge of learning what happened – and is happening – on the ground to create a culture of learning. These efforts go beyond the collection of publically available data to understand what drives differences in outcomes and experience at the state level. Initial results indicate that people need to understand how much competition exists, how complicated the technology is and how critical the role of outreach and navigation is in communicating and assisting the people who need coverage and assistance.
On the roll of federalism specifically, Nathan reinforced that ideas can and should come from the country. It is through states that the country can support the continued evolution and improvement of the ACA. The hope, Nathan said, it to “find states that are going to teach us and lead us.”
As we celebrate the 50th anniversary of Medicare, a program the panel called ‘still a work in progress’ the lessons of our states may be critical guideposts for the future.
Plenary: Now What? Opinions on the Issues, Policies and Priorities that Will Drive 2015 Health Policy
The final panel of the 2015 National Health Policy Conference provided insights from media and public opinion on what is driving the current and future health policy agenda. Panelists engaged in a detailed conversation and identified and predicted how the politics, policy, and legislative debate will play out in 2015.
The panelists spent a significant amount of time discussing the pending Supreme Court case, King v. Burwell. Avik Roy, Manhattan Institute, signaled the potential disruption King v. Burwell could cause if successful, although he does not think that the long-term fate of exchanges would be destroyed. Noam Levey of the Los Angeles Times similarly did not believe that the outcome of the Burwell case will ruin exchanges permanently, because states will have enough incentive to set up their own.
Panelists also talked about the roles of the current administration and Congress and possible big name news stories within the next year. They report that polling data suggests that Republicans will be blamed if subsidies are discontinued. On the other end, Morning Consult’s Michael Ramlet is interested in seeing what polling data will show about the relationship between technology and primary care. Julie Rovner, Kaiser Health News, is intrigued as to what health policies the Republican Party will put forward with the upcoming ruling on King v. Burwell and presidential election.
Marilyn Werber Serafini from the Alliance for Health reform moderated the panel.