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-



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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 competi- tiveness 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 fac- tor 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- 22

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22 VALUE IN HEALTH CARE ments and technologies, relative to the evidence of their effective- ness, raise basic questions about the orientation and incentives of healthcare training, financing, and delivery. 5. 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. 6. 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. 7. A single agreed-upon measure of value is not available. 8. A comprehensive, coordinated system-wide approach to assess and improve the value of health care does not exist in the U.S. health- care system. Goals: Provide a forum for discussion of stakeholder perspectives on mea- suring 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 implica- tions 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 dif- ferent 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

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229 APPENDIX A (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 hori- zons, 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 (Continued) • 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.

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20 VALUE IN HEALTH CARE • 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: • rancois Sainfort (University of Minnesota School of F Public Health)—Consumer-directed health plans • avita Patel (United States Senate)—Value-based insurance K design • aroline Rossi Steinberg (American Hospital C Association)—Tiering • eth Serxner (Mercer)—Wellness S 5:45 RECEPTION

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2 APPENDIX A 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 – organization to improVing Value 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

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22 VALUE IN HEALTH CARE • Disease management Tracey A. Moorhead, DMAA: The Care Continuum Alliance DISCUSSION Initial post-presentation responses: • Ronald Paulus (Geisinger Health System)—EHRs • arah Scholle (National Committee for Quality S Assurance)—Medical home • inda Magno (Centers for Medicare & Medicaid L Services)—Disease management [Lunch 12:30 to 1:30] 1:30 session 6: aligning – noW tHe system to promote Value 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 o Near term/quick hits o Long term o 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