Health Policy Program

New America Foundation
 

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The New America Foundation’s Health Policy Program is committed to achieving a high-quality, coordinated, and economically sustainable health care system. Building on its successful advocacy for increased access, New America’s Health Policy Program has shifted focus to the next crucial step in reform: improving the quality and cost-effectiveness of America’s health care delivery system. The Health Policy Program is committed not only to discovering best practices in medicine and health promotion, but also to communicating these  practices to the broadest possible audience, including policy makers, health care professionals and especially consumers of health care, through scholarly work, convening and original journalism.

Controlling rising health care costs and improving the quality of U.S. health care requires a transformation of our chaotic, dysfunctional, and disorganized health care delivery system. Achieving that transformation requires a new framework for thinking about the health care system and new policies that will help payers and providers bring about change. New America Foundation's Health Policy Program is uniquely positioned to produce the innovative policy solutions to address these critical objectives. The relationship between health care costs and the inefficient and often unsafe system for delivering medical services has long been central to the work of New America’s acting director Shannon Brownlee, trustee Atul Gawande, and senior research fellows Phil Longman and Leif Wellington Haase.

We have aligned our focus on four key areas of interest, all of them leverage points for health care reform. Our goal is to prepare the public for the delivery system restructuring that's needed, and to open new pathways for providers and payers. Our four areas of interest are:

• Transparency: Making price, quality, safety and effectiveness transparent and useful to patients, providers and payers;
• Primary Care: Appraising and amplifying innovations in the delivery of and payment for primary care, the bedrock of high-functioning delivery systems;
• Professionalism: Redefining professionalism in medicine to engage providers as stewards of reform; and
• Infrastructure: Analyzing the current health care infrastructure and projecting future needs.

These initiatives play to the comparative strengths of the New America Health Policy Program. Few think tanks are as intellectually or institutionally prepared to address the next great step in the health care debate, which is reforming the delivery system infrastructure and the actual practice of medicine. By harnessing our core strengths of ahead-of-the-curve thinking and persuasive communication, the Health Policy Program will build on our niche as a source of sound analysis and creative policy ideas for controlling costs, improving care, and spurring the national debate on delivery system transformation.

Making the Patient Experience Transparent:

Most patients remain unaware of the magnitude of the health care delivery system’s failings, with few recognizing the link between poor organization, substandard outcomes, and high costs. In the coming year, the Health Policy Program will pursue three key initiatives to make the patient experience transparent to patients and policy makers. These efforts will engage stakeholders in delivery system reform and improve the efficiency of health care markets.

Real Best Hospitals Guide:  U.S. News & World Report’s annual “Best Hospitals Guide” receives considerable attention, yet experts in the field of health care quality are alarmed by its flawed methodology, based largely on reputation surveys that reinforce existing assumptions about high-profile (and often costly) hospitals. Work by the Dartmouth Atlas Project has shown that many of the hospitals rated highest by U.S. News deliver large volumes of avoidable – and often dangerous – care.

Data-based hospital ratings exist (Consumer Reports and CMS Hospital Compare, for example), but they are difficult for the public to interpret and have failed to gain widespread recognition. The Health Policy Program is developing a more accurate and useful hospital ranking system, to be published annually in a special issue of the Washington Monthly, which will compile metrics both from government, commercial and academic databases. The “Real Best Hospitals Guide” will be distinguished from existing rankings by the weight it gives to patient satisfaction, and to delivery systems that excel in prevention, primary care, family medicine, geriatrics, patient safety, and service to the community.

All-Payer Databases: Health care markets fail in part because purchasers (employers and patients) lack such information as the cost of medical services, and thus cannot choose wisely among health care providers.  The Health Policy Program is seeking partners, including payers, patient advocates, and government, in an effort to promote policies that require public disclosure of claims data by all payers, including private insurers.

Shared Decision Making: The Health Policy Program is working with the Foundation for Informed Medical Decision Making (FIMDM), a non-profit organization developing balanced, unbiased patient decision aids and promoting shared decision making. With FIMDM, New America will convene a meeting early in 2011 aimed at developing consensus among stakeholders around
certification standards for patient decision aids and the process of shared decision making. This is the first step in an ongoing collaboration to amplify the crucial need for patients to actively engage in making informed medical choices, and to ensure access to accurate and
unbiased information about their medical options.

Redefining Medical Professionalism:

Avoiding Avoidable Care: The initial phase of this effort involves convening a series of meetings to engage clinical leaders and patients in sharing responsibility toreduce the use of unnecessary medical services. The first two meetings, which will be co-hosted by the American Board of Internal Medicine, the Institute of Medicine, and the Lown Foundation (founded by cardiologist and Nobel laureate Bernard Lown), will address unnecessary care, and the role of the clinician in addressing this enormous and costly issue.

These meetings will bring together clinical leaders to own the problem of avoidable care, use their influence to educate the medical community, the public, and other stakeholders, and to discuss concrete paths clinicians can take to reducing unnecessary utilization. The deliverables will be academic publications, press coverage, a set of recommendations for physician specialty societies, and a subsequent meeting organized at the Institute of Medicine.

Identifying and Amplifying Primary Care Innovation:

The Affordable Care Act has spurred providers across the spectrum to reevaluate their delivery of care and develop more efficient, better-coordinated, safer systems. Most face financial disincentives inherent in fee-for-service payment, and many are doing good work in isolation, unacknowledged and unaware of other’s efforts. This project will include a series of longitudinal studies, chronicling the efforts of providers to become more organized, efficient, and effective. The program will produce white papers that quantitatively examine the reform process to in turn inform popular articles and meetings aimed at raising the visibility of these new best practices.

Reconfiguring the Health Care Infrastructure:

Health Care Workforce: Health care infrastructure and resources have a powerful effect on utilization and thus spending. Yet, the U.S. has taken only sporadic and largely uncoordinated stabs at defining and regulating the health care infrastructure (which includes the
physician, nurse and other provider workforce, health IT, and such “brick and mortar” resources as hospital and ICU beds). Many such efforts have aimed to remedy perceived scarcities, and few policy makers have recognized the potential for excess capacity.  The U.S. needs a systematic approach to define the medical needs of the population, understand the link between infrastructure and utilization, and then adjust resources to ensure efficient delivery of services. The Health Policy Program, funded by the Rockefeller Foundation, is  working to determine the effects of restructuring the health care workforce on sector productivity.