AcademyHealth Annual Research Meeting: 30 Years of Translating Research into Policy
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
These days, though, costly legislation is likely to have at least a couple of analyses underpinning it, including Congressional Budget Office and private sector analysis. The analysis may include:
- What it will cost
- Potential impact
- How constituents will be affected
- Impact on disadvantaged populations
Jack Ebeler, the initial director of the Robert Wood Johnson Foundation’s health care group, and now a principal with Health Policy Alternatives, an advisory group on federal policy making based in Washington, D.C., pointed out that the “process of legislation is not journal to legislator to law—nor should it be.” Support agencies and intermediaries provide technical expertise, review of research and gaps and judgments on policy directions, “including when it’s not’s time to go forward,” said Ebeler, who also pointed out that health services research can sometimes reveal that an initiative is not worth pursuing. “That is a huge contribution that is often overlooked,” said Ebeler.
Ebeler also ticked off a list of health services research needs going forward including:
- What works in which situations and how?
- How to assess short term and long term cost effects?
- What is the minimum amount and quality of evidence required for adoption?
- How to disperse change that works?
- What is the reasonable pace of change?
- What are unintended consequences?
- How to stop things that don’t work?
- What’s next?