HCFO Year In Review

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The following review of the past year highlights the significant progress that the HCFO program made in achieving its goal of supporting research and policy. Moreover, the year was marked by notable contributions by HCFO-supported researchers whose studies continue to inform policymakers, practitioners and other key stakeholders.

Activities to Support 2009 Policy Reform

Starting in late 2008 and continuing through 2009, HCFO convened meetings and supported publications designed to explore key issues that were likely to emerge throughout the reform discussions.

Insurance Choices: Behaviors of Firms and Their Workforces — HCFO invited a small group of individuals to discuss how best to predict firm and workforce response to future health care reform. Participants were asked to 1) identify key questions that policymakers need to answer about the impact of reform on employer and employee behavior; 2) discuss the data needed or available to understand the potential employer and employee response; and 3) develop a strategy for linking and collecting new data to inform these questions. The meeting discussion was captured in a brief, “Insurance Choices: Behaviors of Firms and Their Workforces.”

Benefit Design — HCFO convened a work group, bringing together senior level policymakers, researchers and industry experts to explore market innovations in benefit design, describe how they are currently being implemented, and discuss the potential for expansion. The group, chaired by John Bertko, also examined what organizations of varying sizes and sectors think about benefit design. Two publications based on the meeting discussions include “Health Care Benefits — Creating the Optimal Design” and “An Analysis of Cost-Sharing Levels in Individual and Small-Group Coverage.”

Implications of the Supply and Organization of the Delivery System on Health Care Reform — HCFO assembled a work group, bringing together senior level policymakers, researchers, and industry experts to examine the implications of proposed reforms on expanding coverage and access to care in light of the current supply and organization of the delivery system. Robert Berenson, M.D., and Hal Luft, Ph.D., co-chaired this work group. Following the meeting, Sean Nicholson, Ph.D., published “Will the United States have a Shortage of Physicians in 10 Years?”

The Impact of the Economy on Health Care — This invitational meeting, chaired by Michael Chernew, Ph.D., brought together a group with diverse expertise to discuss the most likely areas of economic impact on the health care sector, the extent to which existing literature provides evidence about the magnitude of the potential impact, and additional research and analysis that would be helpful to policymakers as they consider potential stimulus proposals or health care coverage options. The publication,  “Impact of Health Care on the Economy” captured the discussion.

Geographic Variation & Health Care Cost Growth: Research to Inform a Complex Diagnosis

As policymakers grappled with developing a structure for a reformed health care system, the subtext throughout has been whether costs will be controlled. HCFO-funded studies are helping to answer that intractable question. In 2009, HCFO sponsored an invitational briefing featuring findings from six grants addressing issues of geographic variation and cost growth. The group, chaired by Robert Berenson, M.D., considered the reasons for variation, whether the variation is the same for all payers, and whether marginal services are linked to improved health outcomes. They also discussed the fact that developing the most appropriate policy levers, such as blunt payment cuts or other incentives for decreasing variation in health care costs and reducing cost growth, remains a challenge. The meeting discussion was captured in the brief, “Geographic Variation and Health Care Cost Growth: Research to Inform a Complex Diagnosis.”

Dissemination Tools — Changes and Improvements

In 2009, HCFO launched a new website (www.hcfo.org). Its updated features are designed to assist users in more easily finding useful information about the program and the work it supports. Visitors to the site will see:

• Findings from studies examining key issues in health care financing and organization, as well as analyses of hot topics at the forefront of current policy discussions;
• The latest news from the initiative, grantees, and the health services research and policy arenas;
• Redesigned search functions that allow easier access to information relevant to researchers, policymakers, practitioners, and other HCFO stakeholders;
• Information on current and past HCFO-funded research plus facts and figures on HCFO’s grant-making process.

The website houses the HCFO Findings Briefs, eight of which were published in 2009. This in-house publication highlights the work of a HCFO grantee and discusses the important policy implications of the study findings. Also on the website is the HCFO e-newsletter, What’s New with HCFO?, which is sent to approximately 6,000 recipients. The e-newsletter is designed to provide recipients with information on new program activities. It features a “Hot Topic,” “Grantee Spotlight,” and “This Month in the News” sections, as well as program announcements and grantee publications.

While HCFO’s current dissemination tools have worked successfully, we are cognizant of the changing communication environment, including the development of a vast array of social media vehicles. This year, we began examining how we could leverage current technology to further the mission of the program. In the coming months, followers will find HCFO on Twitter. We will use this “micro-chat” vehicle to post messages about the latest HCFO offerings and news about our grantees, and direct followers to information on health care financing and organization, as well as markets and delivery systems. Our goal is to build a community of followers who we may not be reaching now and to leverage our resources.

Grantee Briefings

This year, we were particularly pleased with the success of our grantee briefing series. These briefings provide our grantees with feedback from participants with research and policy expertise in the subject area, with the goal of assisting the researchers as they complete their work and plan for upcoming dissemination activities. We have found that this early feedback from both a research and policy perspective helps in tailoring dissemination so that it's available and credible to an appropriate policy audience. It is a two-way street, since those attending the off-the-record briefing also get an opportunity to learn about upcoming research prior to publication. Seven HCFO grantees participated in briefings this year. Two of these briefings offer examples of timely analyses currently in HCFO’s portfolio. Patricia Ketsche, Ph.D., and Kathleen Adams, Ph.D., presented early findings from a grant on the “Incidence of Financing National Health Expenditures.” The goal of this study is to analyze the incidence of financing public and private health expenditures from all sources, distributed across family income groups. The grantees had a vigorous discussion with participants and received valuable feedback on their analysis of the distribution and sources of health expenditures. Likewise, during her grantee briefing, researcher Alison Galbraith, M.D., engaged participants in a discussion on her analysis of the “Effects of High-Deductible Health Plans on Families with Chronic Conditions.” Galbraith also received valuable feedback on a draft manuscript.

HCFO Grantees — In Print and in the News

The timely, relevant research of HCFO grantees became a point of reference as health reform began to consume the policy discussions in 2009. This past year, 23 HCFO-funded researchers published findings from their studies in journals such as Health Affairs, Health Services Research, Inquiry, and the New England Journal of Medicine, as well as other print and web publications. Their studies addressed issues such as:

• Premium and cost-sharing subsidies under health reform
• Health information technology and patient safety
• Coordination of care by primary care practices
• Factors contributing to health care spending growth

HCFO researchers were also called upon this year to brief policymakers directly on the implications of their studies for a reformed health care system. They discussed their analyses with Congressional staffers, and staff from MedPAC, the Government Accountability Office, the Centers for Medicare and Medicaid Services, and the Institute of Medicine.

Funding Research to Inform Policy

A hallmark of the HCFO program is its funding of investigator-initiated research. The following five grants were awarded in 2009:

• Large Employers Use of Workplace Health Clinics — Ha T. Tu/Center for Studying Health System Change
• Reducing Prenatal Smoking: What Role Can State Policies Play? — E. Kathleen Adams/Emory University
• Price Responsiveness in Health Plan Choice: Evidence for Policymaking — Laurence Baker & Anne Royalty/Stanford University School of Medicine
• The Effect of Public Insurance Coverage and Provider Reimbursement on Access to Dental Care: Evidence from the SCHIP Expansion —  Thomas Buchmueller/University of Michigan
• The Incidence of Financing National Health Spending — Patricia Ketsche & E. Kathleen Adams/Georgia State University Research Foundation

HCFO also launched a special topic solicitation in 2009 and received 43 brief proposals that could contribute to the evidence base on the impact of Medicare Part D. The solicitation coincided with the CMS announcement to make Part D available to researchers. Nine applicants were invited to submit full proposals, which are currently under review.

The Year Ahead

The year ahead will likely present many of the same challenges of 2009. The level of economic recovery remains uncertain and the research needs may be slow to take shape. HCFO will continue its tradition of providing guidance to applicants with proposal ideas. We will also continue to leverage the many important facets of the HCFO program to ensure that we remain a go-to resource for policymakers.