PERSPECTIVES ON ESSENTIAL
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
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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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Suggested citation: IOM (Institute of Medicine). 2012. Perspectives on Essential Health Benefits: Workshop Report. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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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
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.
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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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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.
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