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What Are Key Considerations for Health Reform?

Having the right evidence, using high-value care, and developing strong incentives to improve payment and delivery systems are among the ways we can improve healthcare.
Published Online: Feb 20,2017
Dan Leonard, MA
By most accounts, healthcare reform will be driving headlines throughout the first half of 2017. Although it is fairly certain that the Affordable Care Act will be repealed, what is less certain is how a final replacement bill might be structured. Many policy makers in Washington have made statements about the need for marketplace competition, a system that is patient-driven with less federal government intervention and a flexible set-up via block grants to states, among other priorities.

Regardless of political party or preferences, healthcare stakeholders first need to work together to develop and implement provisions that achieve the important goals of improving health outcomes, improving the healthcare system, and lowering costs. Over the long run, if our health system ensures that patients have access to the right treatments and services at the right time, then we should realize improved health outcomes and lower costs.

To meet these shared goals, it is critical that we examine several key areas of healthcare, such as ensuring we have the right evidence to make key decisions, fostering the use of high-value care, and developing strong incentives to improve payment and delivery systems. In particular, we should focus on the following 10 areas:
1. Collaborating on Data
In large part due to technological innovation, we are now starting to see the benefits of a revolution in healthcare data and, with it, the potential to make healthcare payment and delivery even more effective and cost-efficient. Through electronic health records, claims data, and even wearable devices, we are able to gather insightful real-world evidence (RWE) about how healthcare is being delivered, the quality of that care, and how biopharmaceutical treatments are performing in patients in everyday settings. This is even an area in which segments of the biopharmaceutical and insurance sectors have been able to collaborate to conduct real-world studies1 designed to determine how to most effectively and economically treat disease, thereby bringing value to our healthcare system. How payers will utilize this evidence in making coverage decisions is still a work in progress, however, as new methods are being developed2 to ensure the quality of the data, how a research study is conducted, and how the evidence is evaluated.3 RWE is likely to grow in importance thanks to the 21st Century Cures Act, which specifically addresses its application and calls on the FDA to develop a program to consider how this information could be used and evaluated.

Going forward, it is important to have the infrastructure and processes in place to determine whether these and other changes are moving us closer to or further from the Triple Aim. RWE based on comparing patients who experience changes versus previous care and/or comparing them with patients who are not experiencing changes could help provide the evidence needed to inform future innovation.
Additionally, broader access to research-quality data found in taxpayer-funded databases could help researchers tackle a host of healthcare questions that cannot be addressed through other information sources. Although CMS has allowed4 biopharmaceutical companies to access certain federal databases, access to state all-payer claims databases remains limited. Above all, by having ongoing assessments of how patients are experiencing care, we can make adjustments to ensure that positive outcomes remain front and center.