June 2018

For us, Going Below the Surface means rolling up our sleeves, asking tough, uncomfortable questions, and working with a variety of stakeholders to address how well we are spending our health care dollars in the US. Each month, we’ll dig deeper on what’s being discussed and what it means. We hope you enjoy this first issue and encourage you to share, sign up and follow us between issues using #GoingBelowTheSurface.

Questions or comments to help us improve the newsletter? Drop us a line. And please, continue the conversation with colleagues, friends and family so that together we can address the challenge of how best to use our health care resources.

Digging Deeper on the Research


JAMA
Articles on Spending Skim the Surface

Several JAMA articles published during the last few weeks focused on the differences in health spending in the US versus our European counterparts, asserting that we spend more in the US but are not achieving better health outcomes.

But the numbers don’t tell us the full story, according to a Health Affairs Blog article led by Leslie Greenwald of RTI International. She points out that, while the JAMA articles focus on drug prices as a driving factor for increased health spending, the data the articles use from the Organization for Economic Cooperation and Development do not include pricing information, utilization intensity, and variation in price and service use across the US.

Why it matters: As Greenwald writes, “[w]e need to be cautious of study limitations when making policy proposals,” and understand that there are a variety of factors across health care that are driving spending. Trying to pin spending challenges on just one aspect of health care ignores the complexity and nuances of our health care system. That’s why we need to go below the surface and understand how all of these factors are affecting our spending. Read Greenwald’s article.

We Under-investing in Medical Technology?

Advances in medical technology  including devices, diagnostics, surgical procedures and medications – have increased life expectancy and quality of life for many patients post-diagnosis. A survey of US physicians published in the Journal of Managed Care & Specialty Pharmacy provides insight on their perceptions regarding which medical innovations had the biggest impact on US patients diagnosed with debilitating health conditions. According to the survey by RTI Health Solutions and the National Pharmaceutical Council, the majority (56 percent) of improvements in health outcomes since 1990 were driven by pharmaceutical and biopharmaceutical innovations.

Why it matters: These findings suggest that value assessments should be applied broadly to all medical technologies to ensure the best return on investment in health care services. By taking a critical eye to not just spending across different health care sectors, but also the benefits achieved, we can better direct our health care resources.  Maybe we are under-investing in some of the most valuable facets of health technology? View the findings.

What We’re Reading in the Journals

We came across many peer-reviewed articles about health spending, so we dug through them all and chose to share a few key studies on a common theme that caught our attention:  low-value care and wasteful spending in our health care system and how we can tackle those challenges.

  • High Spending Growth Rates for Key Diseases in 2000-14 Were Driven by Technology and Demographic Factors, Abe Dunn, Bryn Whitmire, Andrea Batch, Lasanthi Fernando, and Lindsey Rittmueller, June 2018, Health Affairs
    Increases in health care spending on key diseases can be attributed to several factors: the use of new and often cost-effective technologies, a shift toward preventive services and an aging and more obese population. The study also notes that there are significant inefficiencies in the health care system, such as overtreatment, failure to coordinate care, and administrative complexity. Addressing these inefficiencies could help to reduce health care spending or to focus spending where there is greater need or value for patients.
  • Choosing Wisely Campaigns: A Work in Progress, Wendy Levinson, MD, Karen Born, PhD, Daniel Wolfson, MPP, May 15, 2018, JAMA
    Choosing Wisely, an international initiative to reduce overuse of unnecessary treatments, has gained traction in raising awareness of the issue but its impact thus far has been modest. Its real success over the next five years will be measured by the ongoing engagement of physicians in interventions that go beyond conversations and recommendations and, more importantly, by associated outcomes.
  • Adding Cost-Effectiveness to Define Low-Value Care, Ankur Pandya, PhD, May 15, 2018, JAMA
    Reducing low-value care has been hampered by a lack of agreement on the definition of “value”; basing assessments of low-value care on clinical issues of risk and benefit alone might not be sufficient. Should we consider whether cost-effectiveness analysis could be used in the evaluation of low-value care?

Dialogues on Health Care Spending

Health care spending conversations are taking place across the country at events, online and around the water coolers. We’ve flagged a few conversations for your attention and hope that you’ll also engage with the discussion online via #GoingBelowTheSurface.


About Going Below the Surface

The Going Below the Surface initiative was launched by the National Pharmaceutical Council in 2018 to broaden and improve the conversation around how health care resources are used in the United States. The initiative is aimed at better understanding the roots of the nation’s health spending and investments by promoting a discussion that is firmly based in health policy and systems research. Our goal is to provide clarity on how best to optimize health care spending so that patients receive the right care while simultaneously providing the right incentives to sustain next-generation innovation to improve patient well-being and health system efficiencies. To view the Going Below the Surface partners, visit www.goingbelowthesurface.org.

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