In the same week that the Obama Administration has stated its commitment to overhauling the health care system, the FRESH-Thinking Capstone Conference adjourned yesterday morning to discuss next steps in health care reform. The event is a cross-section of health care experts—academics, practitioners, economists, industry insiders—devoted to fixing the health care system.
The morning began with Stanford Health Policy core faculty member Victor Fuchs welcoming the hundred plus attendees. Fuchs is co-director of the FRESH-Thinking Project with Ezekiel Emanuel. Emanuel stepped down from the Project to join the Obama Administration earlier this year. The Project has spent the past years considering all aspects of health care reform, and this conference is the capstone event of the group's findings. The morning talks look at the cost side of reform.
The first morning speaker was John B. Shoven, Director of the Stanford Institute for Economic Policy Research (SIEPR), who queried the crowd "is it possible to put health care on a diet?" Shoven's focus was on universal coverage and how it can be paid for. After discussing the logistics of who the uninsured are and the current taxation approach, he disavowed the crowd of two giant universal health care reform myths: shared responsibility and the middle class not having to shoulder health care costs. Shoven's take aways were "it's not necessarily that we should have new value added tax. It's that we should have a dedicated tax … We should not separate the benefits from the costs."
Shoven's talk was followed by UC Berkeley School of Public Health Dean Stephen Shortell, who was in Washington, DC, on Monday for President Obama's press conference on the need for comprehensive health care reform. The Blue Cross of California Distinguished Professor of Health Policy and Management started his talk "Organizing Health Care for Higher Quality and Lower Cost" by saying the American health care delivery system "leaks value," highlighting this with a chart showing higher spending not associated with higher quality of care-looks at state-by-state comparison. California "not doing so well."
The rubber meets the road in the delivery of health care. Shortell said the underlying issue is "how can you get more providers in this country to aggregate up … to deliver the kind of care that is going to be needed." The current organization doesn't work, Shortell said, and instead he looks at the potential of accountable care organizations (ACOs)– entities that are clinically and fiscally accountable for the entire continuum of care that patients may need. An ACO has only two jobs, according to Shortell, to continuously improve value of the care it delivers and to provide the evidence on this.
Stanford Health Policy director Alan Garber followed Shortell with a talk assessing "value conscious biomedical innovation." He brought in the role of comparative effectiveness research (CER) in understanding the efficacy of new drugs and technology, and how CER could guide coverage decisions.
Garber mentioned an upcoming report he's doing on CER in prostate cancer treatment. As it stands there's no information "to say that one approach is better than another in terms of survival," he said, only that the treatments vary with side effects and costs. His report maps out these variances-the idea being that the consumer should have access to all options and the varying side effects and costs associated with each treatment. With the backdrop of CER, Garber said this could be a golden era for the right kind of innovator-the innovator who focuses on higher value.