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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Appendix B
Workshop Agendas
THE HEALTHCARE IMPERATIVE:
LOWERING COSTS AND IMPROVING OUTCOMES
An Institute of Medicine Workshop Series
THE KECK CENTER OF THE NATIONAL ACADEMIES
WASHINGTON, DC 20001
WORKSHOP I AGENDA
Understanding the Targets
May 21-22
MEETING AGENDA
Objectives: To identify, characterize, and discuss the major causes of excess healthcare spending, waste, and inefficiency in the United States, to consider strategies that might reduce per capita health spending in the United States while improving health outcomes, and to explore policy options relevant to those strategies.
DAY 1
9:00 am
Welcome, Introductions and Overview
Harvey V. Fineberg, Institute of Medicine
Denis A. Cortese, Mayo Clinic and Chair, IOM Roundtable on Value & Science-Driven Health Care
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David M. Walker, Peter G. Peterson Foundation
9:30 am
Keynote Address
Peter R. Orszag, Office of Management and Budget
What is the state of play of current spending on health care in the United States? What are the implications of unchecked spending on future generations?
10:15 am
Session 1: Unnecessary Services
Chair: Denis A. Cortese, Mayo Clinic and Chair, IOM Roundtable on Value & Science-Driven Health Care
Qualitative description and quantitative estimates on the contribution of unnecessary services to excess healthcare spending, waste and inefficiency.
Elliott S. Fisher, Dartmouth University
Use of services beyond benchmarks where evidence is not established
Amitabh Chandra, Harvard University
Overuse of services, beyond evidence-established benchmarks
David Wennberg, Health Dialog
Choice of higher cost services, over evidence-established equivalents
Mark B. McClellan, Brookings Institution
Defensive medicine
OPEN DISCUSSION
12:00 pm
Lunch Presentation
Eric Jensen, McKinsey & Co.
How does U.S. spending on health care compare to international benchmarks? What are areas of specific excess spending and opportunities for cost savings?
1:00 pm
Session 2: Inefficiently Delivered Services
Chair: Arnold Milstein, Pacific Business Group on Health
Qualitative description and quantitative estimates on the contribution of inefficiency in care organization
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
and delivery to excess healthcare spending, waste, and inefficiency.
Ashish Jha, Harvard University
Costs from mistakes (medical errors, preventable complications)
Mary Kay Owens, Southeastern Consultants, Inc.
Costs from care fragmentation (including duplicate services, treatment delays)
Gary S. Kaplan, Virginia Mason Medical Center
Costs from inefficient use of higher cost providers
William F. Jessee, Medical Group Management Association
Arnold Milstein, Pacific Business Group on Health
Costs from inefficiencies in physician offices and hospitals
OPEN DISCUSSION
3:30 pm
Session 3: Excess Administrative Costs
Chair: Nancy H. Nielsen, American Medical Association
Qualitative description and quantitative estimates on the contribution of excess administrative costs: (1) imposed on providers via external administrative requirements, and (2) incurred for health benefits plan administration.
James L. Heffernan, Massachusetts General Physicians Organization
Regulatory compliance-imposed costs beyond benchmarks
James G. Kahn, University of California–San Francisco
Lawrence P. Casalino, Cornell University
Plan-imposed costs beyond benchmarks
Andrew L. Naugle, Milliman
Plan-incurred costs beyond benchmarks
OPEN DISCUSSION
5:15 pm
Wrap-up Comments for the Day
Arnold Milstein, Pacific Business Group on Health
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J. Michael McGinnis, Institute of Medicine
5:30 pm
Reception
DAY TWO
8:30 am
Welcome and Re-cap of First Day
Arnold Milstein, Pacific Business Group on Health
8:45 am
Session 4: Prices That Are Too High
Chair: Paul B. Ginsburg, Center for Studying Health System Change
Qualitative description and quantitative estimates on the contributions of prices that are too high to excess healthcare spending, waste, and inefficiency.
Cory S. Capps, Bates White
Service prices (beyond competitive market benchmarks)
Jack Hoadley, Georgetown Health Policy Institute
Thomas J. Hoerger, RTI International
Mark E. Wynn, Centers for Medicare & Medicaid Services
Jeffrey C. Lerner, ECRI Institute
Product prices (beyond competitive market benchmarks)
OPEN DISCUSSION
10:45 am
Session 5: Missed Prevention Opportunities
Chair: J. Michael McGinnis, Institute of Medicine
Qualitative description and quantitative estimates on the contribution of missed prevention opportunities, the treatment of which amounts to excess healthcare spending.
Steven H. Woolf, Virginia Commonwealth University
Economic implications of missed prevention opportunities
Thomas J. Flottemesch, HealthPartners Research Foundation
Costs from missed cost-saving primary and secondary prevention opportunities
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Michael P. Pignone, University of North Carolina–Chapel Hill
Costs from missed tertiary cost-saving prevention opportunities
OPEN DISCUSSION
12:30 pm
Concluding Remarks, Upcoming Workshops and Adjournment
Arnold Milstein, Pacific Business Group on Health
J. Michael McGinnis, Institute of Medicine
WORKSHOP II AGENDA
Strategies that Work
July 16-17
MEETING AGENDA
Objectives: To identify, characterize, and discuss the major causes of excess healthcare spending, waste, and inefficiency in the United States, to consider strategies that might reduce per capita health spending in the United States while improving health outcomes, and to explore policy options relevant to those strategies.
DAY ONE
8:00 am
Welcome, Introductions and Overview
J. Michael McGinnis, Institute of Medicine
David M. Walker, Peter G. Peterson Foundation
8:30 am
Keynote Address
Glenn Steele, Jr., Geisinger Health System
What strategies have been demonstrated to lower cost expenditures and improve health outcomes? What are the key success elements and the near- and long-term changes necessary?
9:00 am
Reviewing the Targets
Chair: J. Michael McGinnis, Institute of Medicine
This session will review the analytics from the May workshop, which assessed the amount of potentially controllable waste and efficiency in five broad categories:
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Unnecessary services,
Inefficiently delivered services,
Excess administrative costs,
Prices that are too high, and
Missed prevention opportunities.
Panelists:
Len Nichols, The New America Foundation
Robert D. Reischauer, Urban Institute
OPEN DISCUSSION
10:30 am
Session 1: Knowledge Enhancement-Based Strategies
Chair: Nancy H. Nielsen, American Medical Association
Discussion of knowledge-focused strategies for reducing waste and inefficiency, an assessment of their effectiveness and potential impact on health system efficiency, and a review of the specific opportunities for their implementation.
Peter K. Smith, Duke University
Enhancing clinical data as a knowledge utility
Lucy A. Savitz, Intermountain Healthcare
Evidence-based clinical protocols
Rainu Kaushal, Weill-Cornell Medical College
Electronic health records with decision support
Carolyn M. Clancy, Agency for Healthcare Research and Quality
Comparative effectiveness research
OPEN DISCUSSION
12:30 pm
Lunch
1:00 pm
Session 2: Care Culture and System Redesign-Based Strategies
Chair: Reed V. Tuckson, UnitedHealth Group
Discussion of culture and system redesign-focused strategies for reducing waste and inefficiency, an assessment of their effectiveness and potential impact on health system
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efficiency, and a review of the specific opportunities for their implementation.
Michelle J. Lyn, Duke University
Caregiver profile, efficiency and team care
Kim R. Pittenger, Virginia Mason Medical Center
Care site efficiency and productivity initiatives and incentives
Timothy G. Ferris, Massachusetts General Hospital
Care site integration initiatives
BREAK
Roger Feldman, University of Minnesota
Antitrust interventions
Ashish Jha, Harvard University
Promoting information technology interoperability/connectivity
Frank A. Sloan, Duke University
Service capacity restrictions
Randall R. Bovbjerg, Urban Institute
Medical liability reform
OPEN DISCUSSION
3:30 pm
Session 3: Transparency of Cost and Performance
Chair: Robert S. Galvin, Global Healthcare/General Electric
Discussion of transparency-based strategies for reducing waste and inefficiency, an assessment of their effectiveness and potential impact on health system efficiency, and a review of the specific opportunities for their implementation.
John Santa, Consumer’s Union
Transparency in prices
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G. Scott Gazelle, Institute for Technology Assessment
Transparency in comparative value of treatment options
Paul B. Ginsburg, Center for Studying Health System Change
Transparency in comparative value of providers
Peter K. Lindenauer, Tufts University
Transparency in comparative value of hospitals and integrated systems
Margaret E. O’Kane, National Committee for Quality Assurance
Transparency in comparative value of health plans
OPEN DISCUSSION
5:30 pm
Wrap-up Comments for the Day
Arnold Milstein, Pacific Business Group on Health
J. Michael McGinnis, Institute of Medicine
5:45 pm
Reception
DAY TWO
8:00 am
Welcome and Re-cap of First Day
Arnold Milstein, Pacific Business Group on Health
8:30 am
Session 4: Payment and Payer-Based Strategies
Chair: Paul B. Ginsburg, Center for Studying Health System Change
Discussion of payment and payer-based strategies for reducing waste and inefficiency, an assessment of their effectiveness and potential impact on health system efficiency, and a review of the specific opportunities for their implementation.
Amita Rastogi, Bridges to Excellence
Bundled and fee-for-episode payments
Harold D. Miller, Center for Healthcare Quality and Payment Reform
Value-based payment
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David R. Riemer, Community Advocates
Managed competition
Niteesh K. Choudhry, Harvard University
Lisa Carrara, Aetna
Value-based insurance design
Robin J. Thomashauer, Council for Affordable Quality Healthcare
David S. Wichmann, UnitedHealth Group
Payer harmonization, coordination and/or consolidation
OPEN DISCUSSION
10:45 am
Session 5: Community-Based and Transitional Care Strategies
Chair: Gail Shearer, Consumers Union
Discussion of community-based and transitional care strategies for reducing waste and inefficiency, an assessment of their effectiveness and potential impact on health system efficiency, and a review of the specific opportunities for their implementation.
Kenneth E. Thorpe, Emory
Care management for medically complex patients
Diane E. Meier, Mt. Sinai Hospital
Reform in end-of-life care
Jeffrey Levi, Trust for America’s Health
Wellness/community programs
OPEN DISCUSSION
12:00 pm
Lunch
12:30 pm
Session 6: Entrepreneurial Strategies and Potential Changes in the State of Play
Chair: Kathleen Buto, Johnson & Johnson
Discussion of entrepreneurial initiatives that may change the state of play in ways that substantially reduce waste and inefficiency, an assessment of their potential
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
effectiveness and impact on health system efficiency, and a review of the specific opportunities for their implementation.
Sandeep Green Vaswani, Institute for Healthcare Optimization
N. Marcus Thygeson, HealthPartners
Highest known yield clinical service engineering applications (e.g., smoothing, retail clinics)
Jason Hwang, Innosight
Lower barriers to entry in health care (e.g. competency-based rather than credential-based clinical licensing)
Adam Darkins, Department of Veterans Affairs
Technological innovation
Gerard F. Anderson, Johns Hopkins University
Strategies importable from abroad
OPEN DISCUSSION
2:30 pm
Concluding Remarks, Upcoming Workshops and Adjournment
Arnold Milstein, Pacific Business Group on Health
J. Michael McGinnis, Institute of Medicine
WORKSHOP III AGENDA
The Policy Agenda
September 9-10
MEETING AGENDA
Objectives: To identify, characterize, and discuss the major causes of excess healthcare spending, waste, and inefficiency in the United States; to consider strategies that might reduce per capita health spending in the United States while improving health outcomes; and to explore policy options relevant to those strategies.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
DAY ONE
8:00 am
Welcome, Introductions and Overview
J. Michael McGinnis, Institute of Medicine
Arnold Milstein, Pacific Business Group on Health
8:30 am
Keynote Address
Karen Davis, The Commonwealth Fund
The keynote will explore what we have learned about the relative contributions of the major sources of excessive, unnecessary, and wasteful U.S. healthcare expenditures; what we know about the forces in play, the key strategies necessary to address the problem, and the policy initiatives most likely to make a difference in the near-and longer-term; and how the necessary support might be mobilized.
9:00 am
Session 1: Reviewing the Targets and Strategies
Chair: J. Michael McGinnis, Institute of Medicine
Opening Remarks: David M. Walker, Peter G. Peterson Foundation
This session provides an overview of the state of understanding from the May and July workshops assessing the sources of excess costs (and some prominent examples) and the potential gains from various initiatives.
Estimates of excess costs, by source:
Unnecessary services,
Inefficiently delivered services,
Excess administrative costs,
Prices that are too high, and
Missed prevention opportunities.
Estimates of potential gains, by initiative:
Payment-based strategies,
Care delivery efficiency-based strategies,
Payer harmonization-based strategies,
Transparency-based strategies,
Tort reform,
Knowledge enhancement-based strategies, and
Community-based strategies.
Joseph Antos, American Enterprise Institute
CBO scoring methods and results
OPEN DISCUSSION
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10:45 am
Session 2: Policies Targeting Payments Bundled by Condition, Episode, or Outcome
Chair: Arnold Milstein, Pacific Business Group on Health
Opening Remarks: Harvey V. Fineberg, Institute of Medicine
This session addresses the nature, status, and implementation issues for bundled payment strategies, the pivotal co-factors necessary to maximize the savings potential, and the options to minimize political barriers.
John M. Bertko, The Brookings Institution
Linda M. Magno, Centers for Medicare & Medicaid Services
State of the science, implementation course, and cadence in bundling payments
George J. Isham, HealthPartners
Provider engagement issues
Nancy Davenport-Ennis, National Patient Advocate Foundation
Patient engagement issues
OPEN DISCUSSION
12:15 pm
Lunch
12:45 pm
Session 3: Policies Targeting Care for Medically Complex Patients
Chair: Peter M. Neupert, Microsoft
This session considers policies that might foster delivery system innovations, ranging from care coordination and more efficient caregiver profiles, to shared services arrangements, and patient/family engagement initiatives, including consideration of policies promoting reform of palliative and end-of-life care.
Arnold Milstein, Pacific Business Group on Health
State-of-the-art initiatives
Ronald A. Paulus, Geisinger Health System
Provider perspective
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R. Sean Morrison, Mt. Sinai School of Medicine
Anand K. Parekh, Department of Health and Human Services
Policy perspective
OPEN DISCUSSION
2:15 pm
Session 4: Policies Targeting Delivery System Integration
Chair: Helen Darling, National Business Group on Health
This session addresses the current state and consequences of the fragmentation of health care, and considers the organizational, technical, and financial incentives for integrated and virtually integrated care.
John Toussaint, ThedaCare Center for Healthcare Value
Profile of system fragmentation and elements of integration
Mark E. Miller, Medicare Payment Advisory Commission
Harold S. Luft, Palo Alto Medical Foundation Research Institute
Payment to promote integration
Andrew M. Wiesenthal, The Permanente Foundation
Health information technology to promote integration
OPEN DISCUSSION
3:45 pm
Session 5: Policies Targeting Other Delivery System Innovations
Chair: Paul B. Ginsburg, Center for Studying Health System Change
This session considers policies that might lower barriers to introduction of delivery system innovations, ranging from design of more efficient delivery systems to more efficient use of alternate caregivers.
Steven J. Spear, Massachusetts Institute of Technology
Policies to improve system efficiencies
Mary D. Naylor, University of Pennsylvania
Policies to improve provider profile and use
OPEN DISCUSSION
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
4:45 pm
Wrap-up Comments for the Day
Arnold Milstein, Pacific Business Group on Health
DAY TWO
8:00 am
Welcome and Re-cap of First Day
Arnold Milstein, Pacific Business Group on Health
8:30 am
Session 6: Policies Targeting Administrative Simplification
Chair: Nancy H. Nielsen, American Medical Association
This session considers policies aimed at harmonizing and standardizing payer plans, and billing and reporting requirements, including review of current initiatives, experiences, barriers, and possibilities.
Lewis G. Sandy, UnitedHealth Group
Payer perspective
Linda L. Kloss, American Health Information Management Association
Provider perspective
Harry Reynolds, Blue Cross/Blue Shield of North Carolina
Policy engagement issues
OPEN DISCUSSION
10:00 am
Session 7: Policies Targeting Consumer Preferences for Higher Value Care
Chair: Robert S. Galvin, Global Healthcare/General Electric
This session considers policies that aim to sharpen consumer awareness, focus, and choice of care that delivers higher value.
Jennifer Sweeney, National Partnership for Women and Families
Consumer engagement issues
Dick Salmon, Cigna
Payer perspective
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Dolores L. Mitchell, Group Insurance Commission
Purchaser perspective
OPEN DISCUSSION
11:30 am
Lunch
12:00 pm
Session 8: Pulling It All Together—Getting to 10 Percent
Chair: Arnold Milstein, Pacific Business Group on Health
This session will engage key analysts in the task of each reflecting on the summary estimates from the previous meetings and related sources, and offering their views of the gains possible and the most important issues and strategies to reach the possible.
Elizabeth A. McGlynn, RAND
David O. Meltzer, University of Chicago
Peter J. Neumann, Tufts University
OPEN DISCUSSION
1:30 pm
Session 9: Pulling It All Together—The Policy Priorities and Strategies
Chair: J. Michael McGinnis, Institute of Medicine
This session will engage participants in an open discussion of the policy priorities, how to mobilize support, and possible strategy approaches in the contemporary political environment.
Mark B. McClellan, Brookings Institution
Joseph Onek, Office of the Speaker of the House of Representatives
Dean Rosen, Mehlman Vogel Castagnetti Short-term possibilities and goals Long-term possibilities and goals
OPEN DISCUSSION
2:30 pm
Concluding Remarks and Adjournment
Arnold Milstein, Pacific Business Group on Health
J. Michael McGinnis, Institute of Medicine
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WORKSHOP IV AGENDA
Reaching 10 Percent: Options and Requirements
December 15-16
MEETING AGENDA
Objectives: To consider, identify, and characterize practical strategies to reduce per capita health spending in the United States by at least 10 percent within 10 years, without compromising health status, quality of care, or valued innovation.
DAY ONE
9:30 am
Coffee and light breakfast available
10:00 am
Welcome, Introductions and Overview
J. Michael McGinnis, Institute of Medicine
10:30 am
Looking Back at The Healthcare Imperative Workshop Series
Pierre L. Yong, Institute of Medicine
Review the framework and estimates from the workshop series, and reflections on further needs to improve the numbers going forward.
OPEN DISCUSSION
11:15 am
Identifying the Primary Opportunities
Develop the priority list of the domains of highest importance to target, the cost saving strategies of highest yield and importance.
OPEN DISCUSSION
12:30 pm
Lunch
1:00 pm
Consideration of Different Strategy Scenarios—Reaching 10 Percent
Presentation and discussion of different strategic scenario for reaching 10 percent, including the stakeholders affected and the relative savings potentially achievable in the current delivery system milieu.
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OPEN DISCUSSION
2:30 pm
Break Out Discussions
Three groups, each working on details of a different approach.
4:00 pm
Group Discussion
Report and feedback from each of the three break out groups.
OPEN DISCUSSION
5:00 pm
Wrap-up Comments for the Day
J. Michael McGinnis, Institute of Medicine
DAY TWO
8:00 am
Coffee and light breakfast available
8:30 am
Welcome and Re-cap of First Day
J. Michael McGinnis, Institute of Medicine
9:00 am
Identification of Strategic Options to Reach 10 Percent
Development of strategic roadmap for achieving 10 percent health expenditure savings, including the policies needed to implement the strategies, the potential barriers to implementations, the critical co-factors needed to maximize success.
OPEN DISCUSSION
11:00 am
Cadence Issues
Considerations of timing of implementation of the identified strategic options.
OPEN DISCUSSION
12:00 pm
Summary and Adjournment
J. Michael McGinnis, Institute of Medicine
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