Keeneland 2013 Q&A: Glen Mays
The sixth annual Keeneland Conference begins today in Lexington, Kentucky. Each year hundreds of public health researchers and practitioners meet to share research and translation strategies at the annual conference, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, which is based at the University of Kentucky. This year’s keynote speakers include Paul Kuehnert, MS, RN, senior program officer and director for the Public Health team at the Robert Wood Johnson Foundation; Lisa Simpson, president and CEO of AcademyHealth; and Joe V. Selby, MD, MPH, the first executive director of the Patient-Centered Outcomes Research Institute authorized by Congress.
In advance of the conference, NewPublicHealth spoke with Glen Mays, PHD, MPH, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. Mays is also the co-PI of the National Coordinating Center for PHSSR at the University of Kentucky, which is funded by the Robert Wood Johnson Foundation.
NewPublicHealth: What will be some of the key issues at the Keeneland conference this year, both from the plenary podiums and in hallway conversations?
Glen Mays: One area involves looking at the changing roles and responsibilities of health care organizations in the public health enterprise, especially the changing roles of hospitals in helping to deliver public health activities, in part because of new tax incentives for hospitals to be involved and to play a larger role in delivering community benefit services. We have a number of studies taking a look at that issue, as well as other elements of health care reform such as the accountable care organizations that hospitals are playing an important role in and that are part of new health delivery systems. The hospitals are playing roles and engaging public health activities as part of their health care delivery strategy. So there will be a number of studies looking at various angles of hospital and health care system involvement in public health delivery and the larger issue of integration of public health into new health care delivery strategies under health reform, which is a big area.
NPH: How much discussion do you expect about the Affordable Care Act?
Mays: I think there will be a lot of attention paid to various aspects of the Affordable Care Act and how it is shifting public health delivery and the organizations financing public health services. The innovations that are being funded as part of the community transformation grants, for example, are a major component of the prevention and public health funds under the Affordable Care Act. There are also a lot of interesting new models of public health delivery and public health policy implementation and we’ll be seeing early evidence around implementation and effectiveness of those strategies at the meeting. And, as I mentioned earlier, I think we’ll see studies that are looking at how the Affordable Care Act is facilitating greater coordination or integration between health care delivery and public health delivery.
NPH: The Center for PHSSR has received some recent requests for assistance from public health departments and agencies. What have some of those requests been?
Mays: PHSSR is a field of research that is designed to produce information that can be used in the field of practice, and the Center, as a hub for PHSSR activity, continues to get a growing array of requests from state and local health departments in particular. One of the predominant areas of interest we get questions on is about evidence on return on investment and about the economic value of public health activities. We know that’s been an area of interest for a long time in the field as state and local health departments in particular need to be able to articulate the value of the services that they deliver to their policymakers, stakeholders, payers, funders and others, and so we’ve continued to see an interest in evidence around ROI in public health. So, a lot of the questions that we field these days have to do with “what can PHSSR research really offer us in terms of evidence about the health and economic returns from investments in public health?” Just last week I gave the keynote address at the Texas Public Health Association on ROI.
NPH: And have you been able to make the case for health officials to take to policymakers when making funding requests?
Mays: Absolutely. Maybe increased funding in some situations, maybe simply maintenance of effort in others. In Texas, local health officials are using this evidence in part to engage private sector stakeholders to convince them that it’s worth contributing to public health delivery because of the broad health and economic effects that these kinds of services can have on their communities. So this kind of evidence is being used to engage with a variety of different stakeholders, not only policy officials but also private sector decision makers who have roles to play in helping to support public health activities.
NPH: What’s a strong example of ROI?
Mays: There are several studies to point to, actually. We’ve done some work at the University of Kentucky and there is also some work that our colleagues at University of California have done to look at the effects of public health services on medical care spending and, to look at the question of if we spend more on public health, what we can expect to see in terms of the effect of that spending and the effect of those services on downstream need to spend money in the medical care field. And, based on studies, we are finding more evidence supporting this notion that strategic investments in public health can help to moderate the downstream need for spending in the medical care system. Our work has been looking at that cost-offset question in both Medicaid and Medicare spending. There’s a lot of policy interest in those kinds of questions from a cost-saving perspective.
NPH: Have studies also looked at health improvements in addition to cost savings?
Mays: Absolutely. There is a growing array of studies in the field looking at the health effects of public health delivery in moderating preventable mortality and also looking at more proximate health effects associated with public health delivery, such as moderating injury rates or moderating rates of preventable disease. That continues to be a very important line of research. And then, more operationally, public health practitioners in particular are very interested in research that can help guide their decision making about how to reorganize their public health delivery systems to realize efficiency in their operations.
And so we’ve got a growing portfolio of studies in the field looking at issues such as regionalized service delivery or various kinds of arrangements to improve the efficiency with which we are able to deliver public health services. There will be a number of studies at the Keeneland Conference looking at various elements of service reorganization, regionalized service delivery models, consolidation, these service-sharing arrangements that the Robert Wood Johnson Foundation in particular has been very interested in supporting. We’re starting to see some very important evidence come out of studies looking at those alternative ways of organizing public health delivery. There’s a lot of interest in the field for that kind of evidence that can guide administrative decision making in public health.
One of the keynotes at the Keeneland Conference this year is going to be by Dr. Joe Selby, who is the head of the new PCORI Institute, the Patient-Centered Outcomes Research Institute, that was created by the Affordable Care Act to support comparative effectiveness research in what’s called patient-centered outcomes research. That keynote address, along with some other discussions, are really going to highlight another important theme, which is the need for the field to support more comparative effectiveness research looking at not only clinical interventions but also public health interventions. Another important theme for the meeting is the notion of bringing comparative effectiveness into the public health and PHSSR arena to produce evidence that’s more actionable and can inform decision making in the policy and practice areas.