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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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PERSPECTIVES ON ESSENTIAL
HEALTH BENEFITS

WORKSHOP REPORT

Cheryl Ulmer, Bernadette McFadden, and Cassandra Cacace, Rapporteurs

Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans

Board on Health Care Services

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This study was supported by Contract No. HHSP23320042509XI, Task Order HHSP23337027T between the National Academy of Sciences and the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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ISBN 0-309-21543-9

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Suggested citation: IOM (Institute of Medicine). 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

–Goethe

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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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COMMITTEE ON DEFINING AND REVISING AN ESSENTIAL HEALTH BENEFITS PACKAGE FOR QUALIFIED HEALTH PLANS1

JOHN R. BALL (Chair), Former Executive Vice President, American Society for Clinical Pathology

MICHAEL S. ABROE, Principal and Consulting Actuary, Milliman, Inc.

MICHAEL E. CHERNEW, Professor of Health Care Policy, Harvard Medical School

PAUL FRONSTIN, Director, Health Research & Education Program, Employee Benefit Research Institute

ROBERT S. GALVIN, Chief Executive Officer, Equity Healthcare, Blackstone Group

MARJORIE GINSBURG, Executive Director, Center for Healthcare Decisions

DAVID S. GUZICK, Senior Vice President for Health Affairs, and President, UF&Shands Health System, University of Florida

SAM HO, Executive Vice President and Chief Medical Officer, UnitedHealthcare

CHRISTOPHER F. KOLLER, Health Insurance Commissioner, State of Rhode Island

ELIZABETH A. MCGLYNN, Director, Kaiser Permanente Center for Effectiveness & Safety Research

AMY B. MONAHAN, Associate Professor, University of Minnesota Law School

ALAN R. NELSON, Internist-Endocrinologist

LINDA RANDOLPH, President and Chief Executive Officer, Developing Families Center

JAMES SABIN, Clinical Professor, Departments of Psychiatry and Population Health, Harvard Medical School, and Director, Harvard Pilgrim Health Care Ethics Program

JOHN SANTA, Director of Consumer Reports Health Ratings Center, Consumer Reports

LEONARD D. SCHAEFFER, Judge Robert Maclay Widney Chair and Professor, University of Southern California

JOE V. SELBY, Executive Director, Patient-Centered Outcomes Research Institute

SANDEEP WADHWA, Chief Medical Officer and Vice President of Reimbursement and Payer Markets, 3M Health Information Systems

Study Staff

CHERYL ULMER, Study Director

BERNADETTE MCFADDEN, Consultant

SHADIA BEL HAMDOUNIA, Research Associate

CASSANDRA L. CACACE, Research Assistant

ASHLEY MCWILLIAMS, Senior Program Assistant (through July 2011)

ROGER C. HERDMAN, Board Director

____________________

1 The report summarizes the views expressed by workshop participants, and while the committee is responsible for the overall quality and accuracy of the report as a record of what transpired at the workshop, the views contained in the report are not necessarily those of the committee.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:

CINDY EHNES, President and CEO, California Children’s Hospital Association

SHANA A. LAVARREDA, Director, Health Insurance Studies, and Research Scientist, UCLA Center for Health Policy Research

ROBERT S. MCDONOUGH, Head, Clinical Policy Research and Development, Aetna U.S. Healthcare

SARA ROSENBAUM, Professor and Chair, Department of Health Policy, George Washington University School of Public Health and Health Services

Although the reviewers listed above have provided constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by CHRISTINE K. CASSEL, American Board of Internal Medicine. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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Acknowledgments

The committee and staff are grateful to many individuals and organizations who contributed to the success of the two workshops. Many thanks to the individuals who testified before the committee during the workshops as well as to the numerous individuals who submitted materials to the committee throughout the study process. We would like to especially thank the employees of the National Academies who assisted us with the first workshop, coordinating meeting rooms, as well as setting up and controlling the video, audio, and webcast, and providing liaison with the press: Christian Dobbins, Eileen Milner, Patsy Powell, Christine Stencel, and Nicole Stephenson. Thanks too to Jordan Wyndelts for her work on the project website and development of the public input portal. Additional thanks to Institute of Medicine staff, including Abbey Meltzer for preparing the highlights document of this workshop report. Lastly, we would like to thank the sponsoring staff at the Office of Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, including Sherry Glied, Richard Kronick, Caroline Taplin, Lee Wilson, and Pierre Yong, for their financial support and guidance on this project.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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4 STATE EXPERIENCES WITH DEFINING A MINIMUM BENEFIT STANDARD

Presentation by Dr. Jonathan Gruber, Massachusetts Institute of Technology (MIT) and the National Bureau of Economic Research (NBER)

Presentation by Dr. Jon Kingsdale, Wakely Consulting

Presentation by Dr. Beth Sammis, Maryland Insurance Administration (MIA)

Presentation by Dr. Rex Cowdry, MHCC

Presentation by Representative James Dunnigan, State of Utah House of Representatives

Presentation by Mr. Matthew Salo, The National Governors Association

References

5 MEDICAL NECCESSITY AND USE OF EVIDENCE

Presentation by Dr. Alan Garber, VA Palo Alto Health Care System and Stanford University

Presentation by Dr. Barbara Warren, Consumers United for Evidence-Based Healthcare (CUE)

References

6 INSURER DECISIONS OF BENEFIT COVERAGE AND MEDICAL NECESSITY

Presentation by Dr. Louis Jacques, Centers for Medicare & Medicaid Services (CMS)

Presentation by Dr. Jeffrey Kang, CIGNA Corporation

Presentation by Dr. Virginia Calega, Blue Cross and Blue Shield Association (BCBSA)

Presentation by Dr. Robert McDonough, Aetna

Presentation by Ms. Carmella Bocchino, America’s Health Insurance Plans (AHIP)

References

7 EXAMINING TWO CATEGORIES OF CARE IN SECTION 1302

Presentation by Dr. Kenneth Wells, David Geffen School of Medicine, UCLA

Presentation by Dr. Kavita Patel, UCLA Semel Institute

Presentation by Mr. Paul Samuels, Legal Action Center (LAC) and the Coalition for Whole Health

Presentation by Mr. Peter Thomas, Consortium for Citizens with Disabilities (CCD)

Presentation by Dr. Gary Ulicny, The Shepherd Center

Presentation by Ms. Marty Ford, The Arc and United Cerebral Palsy Disability Policy Collaboration

References

8 NON-DISCRIMINATION IN THE REQUIRED ELEMENTS FOR CONSIDERATION

Presentation by Ms. Sara Rosenbaum, The George Washington University

References

9 ADDITIONAL STAKEHOLDER PERSPECTIVES

Presentation by Dr. R. Sean Morrison, National Palliative Care Research Center (NPCRC)

Presentation by Ms. Jina Dhillon, National Health Law Program (NHeLP)

Presentation by Mr. Stuart Spielman, Autism Speaks

Presentation by Ms. Meg Booth, Children’s Dental Health Project (CDHP)

Presentation by Dr. Andrew Racine, American Academy of Pediatrics

Presentation by Dr. Gerald Harmon, Council on Medical Service, American Medical Association (AMA)

Presentation by Dr. Robert Murphy, American Society of Plastic Surgeons (ASPS)

Presentation by Ms. Linda Fishman, American Hospital Association (AHA)

Presentation by Mr. John Falardeau, American Chiropractic Association

Presentation by Dr. Arnold Cohen, American Congress of Obstetricians and Gynecologists (ACOG)

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press. doi: 10.17226/13182.
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Presentation by Mr. Thomas Sellers, National Coalition for Cancer Survivorship (NCCS)

Presentation by Mr. Troy Zimmerman, National Kidney Foundation (NKF)

Presentation by Mr. Richard Smith, Pharmaceutical Research and Manufacturers of America (PhRMA)

Presentation by Mr. Brian Gallagher, American Pharmacists Association

Presentation by Mr. Bruce Wolfe, Obesity Care Continuum (OCC)

References

10 TWO PRIVATE-SECTOR APPROACHES TO BENEFIT COVERAGE AND DESIGN

Presentation by Dr. Samuel Nussbaum, WellPoint, Inc.

Presentation by Dr. Sharon Levine, The Permanente Medical Group

References

11 DECIDING WHAT IS ESSENTIAL AND EVIDENCE-BASED IN TWO STATES FOR PUBLIC INSURANCE PROGRAMS

Presentation by Ms. Carolyn Ingram, CHCS

Presentation by Dr. Jeffery Thompson, Washington State Department of Social and Health Services

Presentation by Ms. Leah Hole-Curry, Washington State Health Technology Assessment (HTA) Program

References

12 LESSONS FROM CALIFORNIA’S BENEFIT REVIEW PROCESSES

Presentation by Ms. Cindy Ehnes, Ms. Maureen McKennan, and Mr. Andrew George, California Department of Managed Health Care (DMHC)

Presentation by Ms. Susan Philip, California Health Benefits Review Program (CHBRP)

Presentation by Mr. Anthony Wright, Health Access California

References

13 PRIORITY SETTING AND VALUE-BASED INSURANCE DESIGN

Presentation by Dr. Somnath Saha, Portland VA Medical Center and the Oregon HSC

Presentation by Dr. Jeanene Smith, Office for Oregon Health Policy and Research

Presentation by Ms. Jean Fraser, San Mateo County Health System

References

14 ASSESSING AFFORDABILITY AND THE POTENTIAL FOR UNDERINSURANCE

Presentation by Dr. Jessica Banthin, Agency for Healthcare Research and Quality (AHRQ)

Presentation by Ms. Cathy Schoen, The Commonwealth Fund

References

APPENDIXES

A Patient Protection and Affordable Care Act, Section 1302

B Web-Based Questions for Public Input on Determination of Essential Health Benefits

C Stanford Model Contractual Language for Medical Necessity

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Chapter 6

Box

6-1 The Blue Cross and Blue Shield Association’s Technology Evaluation Center Clinical Coverage Criteria

Figure

6-1 Defining benefit plans requires balancing administrative agility or consistency with the need to proactively or reactively define benefits

Table

6-1 Scope of Included Benefits: ACA vs. CIGNA’s Standard Employer Plan

Chapter 10

Figures

10-1 WellPoint, Inc. has various paths for reviewing benefit coverage to make medical policy decisions

10-2 Prostate cancer treatments vary in cost but not necessarily in outcomes

Chapter 11

Box

11-1 Criteria Used by the Washington State Health Technology Assessment Program to Make Coverage Decisions

Figures

11-1 New Mexico’s traditional Medicaid has a broader array of benefits than the State Covered Insurance (SCI) Program

11-2 The Washington Department of Social and Health Services uses levels of evidence to choose covered benefits

11-3 The Washington Department of Social and Health Services considers comparative costs to a reference price when designing pharmaceutical benefits and payment

11-4 Health Technology Assessment (HTA) program coverage decisions may vary between Washington (WA) state and private insurers

Table

11-1 Traditional Medicaid, Medicaid Expansion, and Exchange Plans Vary in Population Served and Benefits Offered

Chapter 12

Tables

12-1 The Covered Benefits, Mandatory Benefits, and Optional Benefits for Plans Governed by California’s Knox-Keene Act

12-2 Independent Medical Reviews (IMRs) by Treatment 2008-2010

12-3 Comparison of 2010 Independent Medical Review (IMR) Results

12-4 Comparison of Grievance and Appeals Processes Under the Knox-Keene Act and the ACA

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The Patient Protection and Affordable Care Act (herein known as the Affordable Care Act [ACA]) was signed into law on March 23, 2010. Several provisions of the law went into effect in 2010 (including requirements to cover children up to age 26 and to prohibit insurance companies from denying coverage based on preexisting conditions for children). Other provisions will go into effect during 2014, including the requirement for all individuals to purchase health insurance.

In 2014, insurance purchasers will be allowed, but not obliged, to buy their coverage through newly established health insurance exchanges (HIEs)--marketplaces designed to make it easier for customers to comparison shop among plans and for low and moderate income individuals to obtain public subsidies to purchase private health insurance. The exchanges will offer a choice of private health plans, and all plans must include a standard core set of covered benefits, called essential health benefits (EHBs).

The Department of Health and Human Services requested that the Institute of Medicine (IOM) recommend criteria and methods for determining and updating the EHBs. In response, the IOM convened two workshops in 2011 where experts from federal and state government, as well as employers, insurers, providers, consumers, and health care researchers were asked to identify current methods for determining medical necessity, and share decision-making approaches to determining which benefits would be covered and other benefit design practices. Essential Health Benefits summarizes the presentations in this workshop. The committee's recommendations will be released in a subsequent report.

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