Voices in Health Care Value

March 2019

Welcome to the third issue of Voices in Health Care Value, the newsletter of the Research Consortium for Health Care Value Assessment (RC-HCVA). This issue highlights work from our colleagues at the Center for Enhanced Value Assessment (CEVA). We appreciate your comments and inputs to subsequent issues. If you are interested in becoming a Colleague in Value (individuals and groups who work in this area or who are simply interested in its findings) please register here.

LEAD ARTICLE

PhRMA Foundation Funds Two New Centers of Excellence in Value Assessment

By George Miller, Altarum

The Research Consortium for Health Care Value Assessment is one of two national Centers of Excellence in Value Assessment established in 2018 by the PhRMA Foundation. (The other is the University of Maryland’s Patient-Driven Values in Healthcare Evaluation (PAVE). The foundation recently announced the creation of two additional Centers of Excellence.

Tufts Medical Center has established the Center for Enhanced Value Assessment (CEVA). CEVA is led by Peter J. Neumann, ScD, Director of Tufts’ Center for the Evaluation of Value and Risk in Health (CEVR), which is our featured “Colleague in Value” in this month’s newsletter (see article below). The standard metric used in traditional cost-effectiveness analysis is the cost pre quality-adjusted life year (QALY). CEVA will explore development of additional elements of value that extend beyond the cost per QALY, based in part on inputs from patients, clinicians, and other stakeholders. The center will also develop infrastructure that supports future work in use of such non-standard value elements in cost-effectiveness analyses.

The Center for Pharmaceutical Value (PValue) at the University of Colorado is directed by Jonathan D. Campbell, PhD. PValue is building on prior research to investigate the use of multicriteria decision analysis in support of decision making regarding pharmaceutical coverage (what drugs are included in an insurance benefit) and reimbursement (rules for payment for use of the drugs). Experiments will be designed to test the benefits of such decision tools in supporting transparency, consistency, and fairness in pharmaceutical coverage and reimbursement decisions.

We welcome these two new centers to the family of Centers of Excellence in Value and look forward to seeing the results of their research and to the possibility of collaborative efforts with them.


RESEARCH CORNER – In Case You Missed It

  • In a study from The National Institute for Health Care Management Foundation, researchers found a large percentage of x-rays and MRIs provided within 30 days of an initial office visit were deemed inappropriate, costing commercial insurers between $4.6 and $5.5 million over the two-year study period. Read the full article here.
  • In an editorial piece by Mark Fendrick and Darrell George in AJMC, they discuss the “Drug Price Iceberg,” cautioning that when it comes to the political iceberg of drug prices, there is more than meets the eye. Read the full article here.
  • In a study recently published in JAMA Internal Medicine, Badgery-Parker and colleagues study the level of hospital acquired complications associated with low-value care in Australia. Findings suggest that the use of 7 low value care procedures in harming some patients, consuming additional hospital resources and potentially delaying care for other patients. Read the full article here.
  • In a follow on to the low-value care webinar hosted by the University of Michigan’s Center for Value-Based Insurance Design and VBID Health, Laura Joszt from AJMC discusses the elements in the webinar including the difficulties in reducing the use of low-value care. Read the full article here.
  • In a study published by Betsy Cliff, Richard Hirth and Mark Fendrick in Health Affairs, they discuss the likelihood of high and low value service use in the first two years after an insurance benefit change. Their findings suggest that interventions aimed at increasing high-value preventive services can cause spillovers to low value services and should include deterrents to low value care. Read the full article here.
  • The Health Care Transformation Task Force recently announced that its provider and payer members had nearly half of their business in value-based payment arrangements. Read the full article here.
  • In a JAMA research letter, Dr. Kevin Platt and colleagues discuss their study on the overuse of self-monitored glucose testing in Type 2 diabetic patients, and the cost it has on the health care system. Read the full article here.
  • In a study by Aaron Schwartz and colleagues, they conclude physician practices may substantially contribute to low-value service usage but it is difficult to know which physicians are more wasteful without measuring their behavior. Read the full article here.
  • In a meta-analysis conducted by Dr. Daniel Morgan and colleagues to understand medical overuse, they found many current practices represent overuse while other services were used inappropriately. Read the full article here.
  • In an interview with the Patient Safety Network’s Perspectives on Safety, Dr. David Meltzer discusses his research in the Comprehensive Care Physician Model that he developed and has been testing to improve the cost and quality of hospital care. The full interview can be read, and listened to here.
  • An article by Anupam Jena and colleagues in the American Journal of Managed Care, examines value frameworks with real-world patient outcomes. Read the full article here.
  • The Health Affairs Council on Health Care Spending and Value announces the twenty member experts and charge of the group. Read the full article here.
  • In an opinion piece, Drs. Navathe, Emanuel and Volpp discuss the potential disconnect between patients and health care organizations/providers in value-based insurance designs. Read the full article here.
  • In a Health Affairs viewpoint article, John O’Shea discusses how the well intentioned efforts to move the health care system to be more effective is adding substantial administrative and regulatory burden on physicians, hospitals and providers. Read the full article here.
  • In this invited commentary, Dr. Peter Groeneveld discusses the nuances in measuring and improving value in health care. Read the full article here.
  • In an NBER working paper, Liran Einav, Amy Finkelstein, and Neale Mahoney identify a specific source of waste in long-term care hospitals. Read the full article here.
  • Only July 12, 2018, the Altarum Center for Value in Health Care sponsored its 8th annual symposium, Sustainable U.S. Health Spending: Serious Issues – Sound Policy Solutions. The full monograph featuring nationally-known health policy experts can be found here.

THE COMMUNITY – A Spotlight Feature on a Colleague in Value

Each issue will spotlight work by a Colleague in Value. This issue’s spotlight is on the Center for Enhanced Value Assessment (CEVA). CEVA’s Anna Legassie provided this information.

The Center for the Evaluation of Value and Risk in Health (CEVR)

As a recent PhRMA Center of Excellence Award winner, The Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center in Boston, MA will develop a new program called the Center for Enhanced Value Assessment (CEVA), led by principal investigator Peter J. Neumann, ScD. CEVA’s mission is to explore the quantitative incorporation of novel elements of value into traditional cost-effectiveness analysis. 

Since its founding in 2006, CEVR has emerged as a leader in value assessment and aims to analyze “the benefits, risks, and costs of strategies to improve health and health care.” In addition to authoring many influential research papers and commentaries, CEVR has developed the Cost-Effectiveness Analysis (CEA) Registry, the largest repository of standardized information on such analyses, with more than 6,000 published cost-effectiveness analyses and 17,000 cost-effectiveness ratios.

Supported by the Center for Excellence Award, CEVA will conduct a literature review using the Tufts CEA registry to assess how often studies report enhanced value assessment elements such as productivity losses and caregiver costs, engage patients and stakeholders to identify those elements that are most important to their experience, augment existing analyses by incorporating these elements, and report findings back to stakeholders. CEVA will support future work by developing tools and publicly available resources to improve consistency across health technology assessments (HTAs).


POLICY TO ACTION

These organizations engage in the process of identifying and finding ways to reduce the use of low-value care services in their target areas. For more information on these organizations and some of their findings please follow the links below:

  • The Costs of Care – Their mission and vision is to provide better care, better health and lower cost. They contend that by working together we can improve the safety, affordability and experience of healthcare.
  • The Center for Health & Research Transformation - The Center for Health and Research Transformation (CHRT) is a non-profit impact organization. CHRT works to transform data and research into useful information that improves the health of people and communities.
  • Healthcare Transformation Task Force - The Health Care Transformation Task Force was established in 2014 with the goal of bringing together patients, payers, providers, and purchaser representatives to act as a private sector driver, coordinator, and facilitator of delivery system transformation.
  • The State of Value in U.S. Health Care – The University of Utah Health provides Value Survey results in an interactive dashboard. Conducting a national survey targeted at consumers, providers and employers, the survey focuses on the what each group things about the component parts of value: quality, service and cost.

UPCOMING EVENTS


PAST EVENTS

The purpose of the RC-HCVA symposium is to bring together our Colleagues in Value to discuss relevant research areas, challenges to implementation, and gaps in what end-users need to inform policy change regarding value in health care. The 2018 Symposium Report can be found here. More information on the 2019 Symposium event will be available shortly. If you are interested in attending, please send an email to beth.beaudin-seiler@altarum.org.


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