For this year’s commencement celebration, Harvard Medical School organized a health care policy symposium for returning alumni. Alumni showed such a great interest in the topic that the event was moved from a classroom to a large amphitheater. HCP Head Barbara McNeil, MD, PhD, launched the discussion with an overview of her research department and an examination of how much it has developed over the 21 years since its inception. McNeil then introduced the lineup of speakers, which included HCP faculty members J. Michael McWilliams, MD, PhD; David Stevenson, SM, PhD; Michael Chernew, PhD; and Sharon-Lise Normand, PhD.
McWilliams’s presentation was entitled “Sick, Aging, and Uninsured: The Value of Coverage.” The premise of his presentation was that health care coverage such as Medicare should be provided at an earlier age. This change in policy would improve long-term health outcomes, reduce disparities, and decrease annual costs per beneficiary after age 65, he says. Other benefits would include the US having healthier working-aged adults, greater equity, and partial offsets to costs of coverage expansion due to earlier care. His presentation stimulated good discussion among the alumni.
The second speaker was Stevenson, who shared a number of alarming trends with the audience in his talk, “Aging and Long-Term Care.” Alumni learned that 90% of older adults in the US lack financial protection from long-term care costs and that spending for these services is projected to double as a percentage of GDP in the decades to come. Stevenson presented a number of possible policy approaches to address these trends. He concluded that long-term care will affect most of us, and that, while there are no easy answers to improve the long-term care system and to make it more sustainable, there are productive ways to move forward, especially if the focus is on systems issues. He also cautioned that the aging of population and rising costs will limit policy options the longer we wait. Alumni members gained a deeper understanding of the importance of addressing long-term care.
Chernew’s presentation, “Value-Based Insurance Design: Benefits and Remaining Issues,” followed. He defined value-based insurance design (VBID) as the notion that benefit packages should reduce copays for highly valued services, or keep them low. To expound upon this idea, Chernew featured a slide of a 2007 New York Times’ article by Milt Fredenheim called To Save Later, Some Employers Are Offering Free Drugs Now, which explained how major employers are offering free drug programs to avoid later paying for expensive treatments. Chernew hopes to see plan designs based on VBID principles offered universally. He also recommends that purchasers expand the diseases targeted by VBID initiatives beyond diabetes and heart disease and to services other than prescription drugs. Chernew acknowledged that further diffusion of VBID plans will require developing implementation strategies while considering system complexity, and he also recognized that VBID will not be a panacea for the challenges facing our health care system. Consumer incentives are likely to be an important component of any future health care system, he says, and VBID principles represent an approach to making those incentives compatible with the desire to encourage high-value (and discourage low-value) care.
The final speaker was Normand, who presented her research in her talk, “Assessing Safety of Medical Technologies in the Real World.” The presentation highlighted some lessons that Normand has learned through her past investigations. She indicated that the use of statistical tools needs to be improved, that more educational opportunities for regulators and clinicians are needed, and that an increase of well-conducted population-based outcomes studies for post-market surveillance is needed as well. She ended by asking the audience their views about their perception of the use of two clinical services that might apply to their patients.
These presenters stirred up considerable discussion after the event. This symposium epitomized the Medical School’s mission: to create and nurture a diverse community of the best people committed to leadership in ending human suffering caused by disease. This session gave alumni a glimpse into four bright minds working on the policy aspects of medicine.
