What Evidence Is Needed To Transform Health And Health Care?

While there is consensus that more reform is needed to improve value in the US health care system, there is less agreement on the mechanisms for achieving that broad aim. Put simply, while many agree on the what, they do not agree on the how.

Efforts to repeal and replace the Affordable Care Act (ACA) remain on Congress’ legislative agenda, with a bill called the American Health Care Act (AHCA) recently passing in the House of Representatives, yet it is unclear whether, or in what form, this bill will pass in the Senate. There is an extensive evidence base evaluating the implementation of the ACA, but more research is needed on the potential effects of the provisions of the AHCA as well as research to see which payment and delivery system reforms could drive improvements in value.

Research intended to inform policy development and to understand and address challenges related to the ACA’s implementation is broad ranging. Programs like State Health Access Reform Evaluation (SHARE) and Policy-Relevant Insurance Studies, both funded by the Robert Wood Johnson Foundation (RWJF), generated important, investigator-initiated research evidence to evaluate the implementation of the ACA at the state level and to address highly policy-relevant questions related to health insurance markets. Projects have examined consumer choice in the ACA marketplaces, pent-up demand for health care, premium assistance in Medicaid, and the impact of the ACA’s smoking penalties, to name just a few.

Other RWJF-funded projects like the Urban Institute’s Quick Strike Health Policy Analysis or Georgetown University’s Rapid Response Project, enabled timely policy analysis to address emerging issues related to health reform. For example, the Urban Institute’s Quick Strike series on the King v. Burwell Supreme Court case was ultimately cited in the court’s decision that upheld tax credits and cost-sharing reductions for millions of Americans.

Georgetown University’s Rapid Response series on the ACA’s small group market definition raised the visibility of the issue for policy makers and helped to inform the deliberations that led to bipartisan policy change. These and many other projects have generated a robust evidence base for evaluating health reform implementation and informing the next steps to improve health and health care in the United States.

In a recent Health Affairs Blog post, AcademyHealth’s President and CEO Lisa Simpson wrote, “Great evidence can serve as an anchor in uncertain times and should be the North Star for policymakers charged with designing a health system that can achieve better care, smarter spending, and healthier people.”

There are many areas where rigorous research results can help to move health policy making forward. The federal cost-sharing reduction payments and whether the new administration will continue to make these payments to insurers have grabbed headlines in recent weeks, as these payments have significant implications for insurer participation and for the affordability of premiums in marketplace plans.

In March 2017, Health and Human Services Secretary Thomas (“Tom”) Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma released a letter to state governors that signaled an interest in promoting greater design freedom and flexibility in the Medicaid program through Section 1115 waivers.

Policy makers need evidence that addresses questions such as: how can we promote greater affordability and stability in the individual insurance market? What would be the impact of provisions to increase flexibility in the Medicaid program? What does the evidence suggest about the effectiveness of health insurance benefit design and cost sharing on consumers’ engagement in health care decision-making?

We know that policy makers and practitioners alike need evidence that is responsive, timely, and credible. We also know that most people in this audience don’t have time to wait the average of seventeen years that it takes for scientific discoveries to be incorporated into practice. Given the fluid nature of the current policy environment, it is critical that research be timely so that it can directly inform the policy process.

A new Call for Proposals (CFP) from the RWJF seeks to fund timely studies aimed at these and other policy-relevant questions. The CFP, managed by AcademyHealth, is open through June 23, 3 p.m. (EDT) and seeks to fund rigorous empirical studies that evaluate policies or predict the potential effects of policies or policy changes intended to transform health and health care systems. The CFP builds on the RWJF’s decades of investment in trying to increase health insurance coverage and improve the value of health care, and the growing multidisciplinary evidence base required to help build a Culture of Health.

Essential components of this Research in Transforming Health and Health Care Systems CFP are that applicants propose studies that are timely and will directly inform the policy process.

What evidence is needed to transform health and health care in the United States? Apply with your ideas.

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