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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
00;00;08;19 - 00;00;18;08
Chris Fleming
Welcome to another episode of Health Affairs This Week, the podcast where Health Affairs editors and guests talk about the health policy news of the week. I'm Chris Fleming.
00;00;18;25 - 00;00;39;16
Michael Gerber
And I'm Michael Gerber. Chris, it's great to join you today. As you know, I'm a long time listener, first time co-host, so go easy on me. As usual, there's been no shortage of health policy news recently. While it got a little lost in the coverage of the politics of Tuesday night's State of the Union speech, much of the drama was actually about essential health care issues like Medicare, COVID 19 and drug prices.
00;00;40;04 - 00;00;47;24
Michael Gerber
And here at Health Affairs, we also had a big week with the launch of Health Affairs Scholar, an open access journal of emerging and global health policy, which I know we're all excited about.
00;00;48;25 - 00;01;08;05
Chris Fleming
We are indeed. Today, though, we're going to talk about another development close to home. The Health Affairs Spending Council released its report this past Friday after four years of deliberation. We have with us today, in fact, Laura Tollen, a senior editor at Health Affairs, who was the director of the council. Laura, welcome.
00;01;08;24 - 00;01;10;07
Laura Tollen
Thanks. Thanks for having me on.
00;01;10;19 - 00;01;11;10
Chris Fleming
Our pleasure.
00;01;11;29 - 00;01;24;23
Michael Gerber
Okay, Laura, in a minute, we'll get to everyone wants to hear, which is how we can address health care spending. But if you can kick us off, tell us a little bit about the council, how it came to be, who was involved in it and what its charge was.
00;01;25;09 - 00;01;47;06
Laura Tollen
Sure. So the Health Affairs Council on Health Care Spending and Value was, which is its formal name, was really the brainchild of Bobby Dubois, who is a member of the Health Affairs editorial board and recently retired as the President of the National Pharmaceutical Council. So it was Bobby and Alan, our editor-in-chief, really, who came up with this concept.
00;01;47;17 - 00;02;15;25
Laura Tollen
They wanted to do something different from our usual activities of the Journal to capitalize on the decades of scholarship that we have had on health care spending. They wanted to try something different. This was a new model for us. And so they proposed doing it, having an expert council to make some recommendations. We knew that in selecting the council members that have choosing the co-chairs was going to be really key.
00;02;16;14 - 00;02;50;09
Laura Tollen
So we had an internal process that resulted in us reaching out to and inviting former Senate Majority Leader Bill Frist and former FDA commissioner Margaret Hamburg to be our co-chairs. And then working with them, we identified a diverse group of council members from all parts of the health care ecosystem. So the charge that Health Affairs originally gave the council when they first met back in 2019 was that they were to recommend ways that the United States can take a deliberate approach to moderating health care spending and growth while maximizing value.
00;02;50;09 - 00;03;14;26
Laura Tollen
So just a little thing we asked them to do. There was a fair amount of discussion initially in the group about whether health care spending growth actually are too high and how would we know? And they decided to answer that question really in terms of value and kind of modified their group, their group goal to achieve higher value health care spending and growth in the United States.
00;03;15;29 - 00;03;34;12
Chris Fleming
Thanks, Laura. So as we mentioned, the council released its report and its recommendations on Friday. Can you give us a real quick high level overview of those recommendations? In particular, my understanding is the council offered recommendations in four areas and also proposed four levers to pull in each area.
00;03;34;21 - 00;03;56;15
Laura Tollen
Sure. It's actually a little the opposite of what you said. There were four levers and then the four sets of recommendation were intended to address those levels. Let me start with the levers. The council for the first half of its time together, the council worked to review the literature on spending and growth drivers and on the efficacy of interventions to address spending and growth.
00;03;57;12 - 00;04;18;20
Laura Tollen
And through that, the look at the literature, they identified four levers that they thought needed to be pulled as part of a comprehensive plan for moderating spending growth. And those were the levers of price. So how much is paid for care volume? How much care is provided next? So that's about the intensity of the type of care that's provided.
00;04;18;29 - 00;04;46;18
Laura Tollen
And then growth in all of those factors. So how fast do the price, volume, and mix grow and change over time? They knew that in order to address health care spending growth in general, they were going to need to pull all of those levers. And so wanting to pull all of those, they cast a really wide net for solutions and eventually settled in four categories, which together can pull all of those levers.
00;04;46;23 - 00;05;05;28
Laura Tollen
And just as a quick little aside, I'm going to tell you what the four categories of interventions were. I want to say first, there was actually one area where they, that they also thought was very important, which is looking at social determinants of health. They really immediately went there and thought, if we're going to talk about controlling spending, we need to talk about that.
00;05;07;17 - 00;05;26;06
Laura Tollen
We did couch them as a Health Affairs staff that we wanted to, well, that's of course, completely valid and very important. We wanted this activity to really focus on the health care system itself. So we did try to reign that in and say let's look at things in interventions that can be implemented within the health care delivery system itself.
00;05;27;08 - 00;06;06;04
Laura Tollen
So with that, they settled on, after looking again on a really broad range of literature, they settled on four categories of interventions. Those were administrative streamlining, price controls and supports for competition, the setting of regional or state level spending growth targets, and the fourth one is continued experimentation and refinement of value based payments. There was also sort of a fifth area that they also recognize is really, really critical to pulling these levers, which is focusing on low value care and the need to reduce or eliminate the use of low value care.
00;06;06;21 - 00;06;22;05
Laura Tollen
But they didn't make recommendations directly in that area because of the work of other expert groups that really have taken that on as their task. But they did assume that there would be ongoing work around reducing low volume, low value care.
00;06;23;01 - 00;07;00;26
Michael Gerber
Thanks, Laura. That's really interesting. I know we don't have enough time to get into all those recommendations and everything in depth today, and we'll be sure to put links for the full report in the show notes as well as a link to last Friday's briefing that we held, which I highly recommend listeners take a look at. But for now, can you highlight one or two noteworthy aspects of the Council's work a little more in depth and anything. Also, I'm curious, it's quite a diverse group, as you mentioned, on the Council and as we saw Tuesday night, consensus can be difficult right now.
00;07;01;16 - 00;07;05;12
Michael Gerber
Were there any areas where they achieved consensus in ways that surprised you?
00;07;06;02 - 00;07;30;28
Laura Tollen
Yeah. Well, first, I should be clear that we didn't have a formal consensus process. So we did work hard to bring everyone along and to come up with recommendations and in particular to craft language that everyone could get behind. Within the group, we had a real, real diversity of views on how the roles of regulation versus market forces.
00;07;31;19 - 00;07;51;10
Laura Tollen
Members wanted to pay a lot of deference to the fact that there are really different political climates in different states, and they didn't think it was going to be possible. They wanted to be practical, present solutions that would be politically feasible in a variety of environments. So they wanted to have something useful to say regardless of what the political environment might be.
00;07;51;10 - 00;08;12;12
Laura Tollen
So they phrased the recommendations in a way that really presents a range of solutions that would allow stakeholders, wherever they are in the country, to kind of start where they are, wherever that might be, whether there's a, you know, some states are really have gone far down the road with, say, spending growth target setting and others that would be anathema.
00;08;13;07 - 00;08;39;05
Laura Tollen
So that said, I guess I was a little bit surprised that in one area that there wasn't any objection, which was the second category of interventions, which is price controls and supports for competition. So everybody agreed on the need for supports for competition, which did not surprise me. And everybody thought we needed the competition to work better in our health care markets.
00;08;39;25 - 00;09;04;00
Laura Tollen
But really that they all came out in favor of at least a limited amount of price regulation or price control. I mean, there were they were very careful about that and said it needed to happen in certain circumstances only. And I encourage you read the report and see how they laid that out. They talked about price control as a second choice
00;09;04;00 - 00;09;25;15
Laura Tollen
if other things don't work. But I guess that did surprise me a little bit that everybody, nobody said no. And there was a sense one of the council members talked about it in terms of a need to put the camel's nose under the tent in terms of trying something in price control. Again, very limited circumstances.
00;09;25;15 - 00;09;48;10
Michael Gerber
I'm certainly excited to see how those recommendations are received and what progress can be made. Clearly, they're very complicated issues and I have no doubt that the three of us could solve them today if we only had more time. But unfortunately, that's all the time we have today. Don't forget, everyone, to check out the report and the recording of last week's briefing and stay tuned for more.
00;09;48;11 - 00;09;49;27
Michael Gerber
And thanks again, Laura, for joining us.
00;09;50;04 - 00;09;50;17
Laura Tollen
Thank you.
00;09;51;01 - 00;10;07;01
Chris Fleming
And thanks from me as well to Laura. And, of course, thanks to our listeners. Be sure to subscribe to Health Affairs This Week wherever you get your podcasts.