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Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
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Appendix A
Workshop Agenda

VALUE IN HEALTH CARE

Accounting for Cost, Quality, Safety, Outcomes, and Innovation


A LEARNING HEALTHCARE SYSTEM WORKSHOP

IOM ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE


NOVEMBER 17-18, 2008

LECTURE ROOM, NATIONAL ACADEMY OF SCIENCES

WASHINGTON, DC 20001


Issues motivating the discussion

  1. Healthcare costs comprise an increasing percentage of both U.S. gross domestic product and federal spending, crowding out other spending priorities, and are often cited as a threat to the competitiveness of U.S. companies.

  2. Health outcomes on many key measures in the United States lag behind those achieved in other countries with significantly lower healthcare costs.

  3. Both for uninsured and for underinsured, cost is a prominent factor in reducing access to care and increasing disparities in health outcomes.

  4. Concerns exist about patient safety and quality of care, and the many examples of both over- and underutilization of medical treat-

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×

ments and technologies, relative to the evidence of their effectiveness, raise basic questions about the orientation and incentives of healthcare training, financing, and delivery.

  1. An aging population with a higher prevalence of chronic diseases, and of many patients with multiple conditions, is a complicating but not determining factor in the trend to higher costs of care.

  2. Emerging as a challenge is the use of high-cost technologies and provider services (e.g., certain diagnostic imaging, medical devices, pharmaceuticals, elective procedures) that may yield marginal enhancement of outcome or are targeted to the benefit of only a small set of patients.

  3. A single agreed-upon measure of value is not available.

  4. A comprehensive, coordinated system-wide approach to assess and improve the value of health care does not exist in the U.S. healthcare system.

Goals: Provide a forum for discussion of stakeholder perspectives on measuring and improving value in health care, and identify the key barriers, opportunities, and suggested next steps.

DAY ONE

8:30

WELCOME AND INTRODUCTIONS

Denis A. Cortese, Mayo Clinic & Chair, IOM Roundtable on Value & Science-Driven Health Care

8:45

KEYNOTE: THE NEED TO IMPROVE VALUE IN HEALTH CARE

What are the key challenges facing the U.S. healthcare system in terms of costs, performance, and value? What are the implications of U.S. healthcare costs for the economic crisis, the nation’s ability to recover, and the welfare of the American people?

David M. Walker, Peter G. Peterson Foundation

9:30

SESSION 1: PERSPECTIVES ON VALUE

To provide context for the workshop discussions, this session will focus on reviewing how the concept of value is viewed from different sectoral perspectives.

Chair: J. Michael McGinnis, Institute of Medicine

  • September 2008 Roundtable Panel Summary

  • Reactor panel

Helen Darling (National Business Group on Health), Bruce Ferguson (East Carolina Heart Institute), Jean-Paul Gagnon

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×

 

(sanofi-aventis), Paul Ginsburg (Center for Studying Health System Change), Gail Griffith (FDA patient representative), Murray Ross (Kaiser Permanente)

DISCUSSION

[Break 10:30 to 10:45]

10:45

SESSION 2: APPROACHES TO ASSESSING VALUE – ILLUSTRATIVE EXAMPLES

Session 2 will feature presentations on the approaches taken to assessing value in various contexts. Speakers will highlight the analytic approaches and tools that are used to characterize and measure value—e.g., outcome measures, cost measures, time horizons, their use, limitations and needed refinements.

Chair: Ezekiel J. Emanuel, National Institutes of Health

Physician evaluation and management services

L. Gregory Pawlson, NCQA

Surgery and other procedures

Justin B. Dimick, University of Michigan

Imaging technologies

Howard P. Forman, Yale University

REACTOR PANEL

Dan Campion (Outcome Sciences), Martha Sylvia (Johns Hopkins), Philip Wang (National Institute of Mental Health)

DISCUSSION

12:30

LUNCH PRESENTATION: PERSPECTIVES ON VALUE FROM THE UNITED KINGDOM

Sir Michael Rawlins, National Institute for Clinical Excellence, United Kingdom

1:45

SESSION 2

Preventive services/wellness

David O. Meltzer, University of Chicago

Pharmaceuticals/biologicals

Newell E. McElwee, Pfizer, Inc.

Personalized diagnostics

Ronald E. Aubert, Medco Health Solutions, Inc.

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×

 

Devices

Parashar B. Patel, Boston Scientific Corp.

REACTOR PANEL

Elise Berliner (Agency for Healthcare Research and Quality), Steve Phurrough (Centers for Medicare & Medicaid Services), Paul Rudolf (Arnold & Porter, LLP)

DISCUSSION

[Break 3:45 to 4:00]

4:00

SESSION 3: APPROACHES TO IMPROVING VALUE – CONSUMER INCENTIVES

Sessions 3, 4, and 5 will present specific examples of current approaches to improve value in health care in three main areas. Each session will explore the nature of the efforts, and the best practices and results to date. Speakers will particularly focus on the evidence of impact and the future potential to improve value with each approach. The first session will focus on the use of a variety of consumer-oriented strategies to promote value. Each presentation will be followed by a reactor.

Chair: Michael E. Chernew, Harvard University

Consumer-directed/high-deductible health plans

Melinda J. Beeuwkes Buntin, RAND

Value-based insurance design

A. Mark Fendrick, University of Michigan

Tiering

Dennis P. Scanlon, Pennsylvania State University

Wellness

Ronald Z. Goetzel, Emory University

DISCUSSION

Initial post-presentation responses:

  • Francois Sainfort (University of Minnesota School of Public Health)—Consumer-directed health plans

  • Kavita Patel (United States Senate)—Value-based insurance design

  • Caroline Rossi Steinberg (American Hospital Association)—Tiering

  • Seth Serxner (Mercer)—Wellness

5:45

RECEPTION

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×

DAY TWO

8:30

WELCOME AND RECAP OF THE FIRST DAY

Denis A. Cortese, Mayo Clinic & Chair, IOM Roundtable on Value & Science-Driven Health Care

9:00

SESSION 4: APPROACHES TO IMPROVING VALUE – PROVIDER AND MANUFACTURER PAYMENTS

Continuing from Session 3, this session will explore examples of approaches to improve value in health care, with a focus on the use of payment design and coverage and reimbursement policy to improve value. The first two presentations will each be followed by a reactor.

Chair: Samuel R. Nussbaum, Wellpoint, Inc.

Pay-for-performance

Carolyn M. Clancy, Agency for Healthcare Research and Quality & Roundtable Member

Coverage and reimbursement decisions

Steven D. Pearson, Institute for Clinical and Economic Review

Incentives for product innovation

Donald A. Sawyer, AstraZeneca

Reed V. Tuckson, UnitedHealth Group

DISCUSSION

Initial post-presentation responses:

  • Robert Galvin (General Electric)—Pay-for-performance

  • Amy Miller (Personalized Medicine Coalition)—Coverage

[Break 10:45 to 11:00]

11:00

SESSION 5: APPROACHES TO IMPROVING VALUE – ORGANIZATION AND STRUCTURE OF CARE

Continuing from Sessions 3 and 4, the final session on approaches to improving value will focus on changing the organization and structure of care to improve value. Each presentation will be followed by a reactor.

Chair: John C. Rother, AARP & Roundtable Member

Electronic health records

Douglas Johnston, Center for IT Leadership

Patient-centered medical home

Arnold S. Milstein, Pacific Business Group on Health

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×

 

Disease management

Tracey A. Moorhead, DMAA: The Care Continuum Alliance

DISCUSSION

Initial post-presentation responses:

  • Ronald Paulus (Geisinger Health System)—EHRs

  • Sarah Scholle (National Committee for Quality Assurance)—Medical home

  • Linda Magno (Centers for Medicare & Medicaid Services)—Disease management

[Lunch 12:30 to 1:30]

1:30

SESSION 6: ALIGNING THE SYSTEM TO PROMOTE VALUE – NOW AND IN THE FUTURE

How could the health system be better aligned to promote value in all aspects of health care, both now and in the future?

Chair: Karen L. Smith, AstraZeneca

• On the horizon

Christine K. Cassel, American Board of Internal Medicine

• Panel discussion

Ezekiel J. Emanuel, National Institutes of Health

Samuel R. Nussbaum, Wellpoint, Inc.

John C. Rother, AARP & Roundtable Member

  • Near term/quick hits

  • Long term

  • Political considerations

DISCUSSION

3:30

CONCLUDING SUMMARY, REMARKS, AND ADJOURNMENT

J. Michael McGinnis, Institute of Medicine

PLANNING COMMITTEE

Michael E. Chernew, Harvard Medical School

John C. Rother, AARP

Ezekiel J. Emanuel, National Institutes of Health

Arthur Garson, Jr., University of Virginia School of Medicine

Karen L. Smith, AstraZeneca

Samuel R. Nussbaum, Wellpoint

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 227
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 228
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 229
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 230
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 231
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine. 2010. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12566.
×
Page 232
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The United States has the highest per capita spending on health care of any industrialized nation. Yet despite the unprecedented levels of spending, harmful medical errors abound, uncoordinated care continues to frustrate patients and providers, and U.S. healthcare costs continue to increase. The growing ranks of the uninsured, an aging population with a higher prevalence of chronic diseases, and many patients with multiple conditions together constitute more complicating factors in the trend to higher costs of care.

A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated systemwide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress.

To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine convened a workshop to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. The workshop, summarized in this volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers and outlining the opportunities for next steps.

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