SYMPOSIUM ON SUSTAINABLE U.S. HEALTH SPENDING SUSTAINABLE U.S. HEALTH SPENDING Serious Issues—Sound Policy Solutions Washington, DC · Thursday, July 12, 2018 SYMPOSIUM MONOGRAPH Paul Hughes-Cromwick and Autumn Valicevic, Editors December 2018 CONTRIBUTORS Peter Bach Melinda Buntin Ceci Connolly Douglas Elmendorf Matthew Fiedler Sherry Glied Jeff Goldsmith Katherine Hempstead William Hoagland Joanne Kenen Alice Rivlin Elisabeth Rosenthal Louise Sheiner Jonathan Skinner Lauren Taylor ALTARUM CENTER FOR VALUE IN HEALTH CARE www.altarum.org | Follow us on Twitter @ALTARUM_SHSS Support provided by CENTER FOR VALUE IN HEALTH CARE SYMPOSIUM MONOGRAPH JULY 2018 CONTENTS PREFACE AND ACKNOWLEDGEMENTS........................................................................................................... 3 CONTRIBUTORS ...................................................................................................................................................... 4 EDITORS .................................................................................................................................................................... 8 SYMPOSIUM AGENDA ........................................................................................................................................... 9 WELCOME AND INTRODUCTION .....................................................................................................................10 PANEL I: GOVERNMENT BUDGETS, HEALTH CARE SPENDING AND POLICY APPROACHES .......10 Connolly—Welcome and Overview ................................................................................................................10 Elmendorf—Government Budgets and Health Care Spending ...................................................................11 Sheiner—Government Budgets, Health Care Spending and Policy Approaches ....................................14 Rivlin—The Complexity of the United State’s Health Care Problem and Possible Solutions ................16 Questions and Answers: Panel I ......................................................................................................................18 PANEL II: NEW PERSPECTIVES ON HEALTH CARE COST DRIVERS ....................................................... 23 Rosenthal—Overview ...................................................................................................................................... 23 Bach—A New Way to Define Value in Cancer Care .................................................................................... 23 Buntin—Explaining Slow Growth in Medicare Spending ............................................................................28 Fiedler—Reforming the Structure of Mediare Provider Payment ............................................................30 Taylor—Social Determinants of Health and Health Care Spending .........................................................34 Questions and Answers: Panel II .................................................................................................................... 37 PANEL III: UNSUSTAINABLE HEALTH CARE SPENDING: SOUND POLICY SOLUTIONS ..................42 Kenen—Overview .............................................................................................................................................42 Goldsmith—Health Trends Post-Obama: Where are Health, Health Costs and Payment Reform Headed? .42 Glied—Identifying Promising Solutions to Real Problems ......................................................................... 47 Skinner—Exnovation, De-Adoption and the Sustainability of U.S. Health Care ......................................51 Hoagland—Unsustainable Health Care Spending: Sound Policy Solutions .............................................54 Questions and Answers: Panel III ................................................................................................................... 57 Sustainable U.S. Health Spending: Serious Issues—Sound Policy Solutions 2 CENTER FOR VALUE IN HEALTH CARE SYMPOSIUM MONOGRAPH JULY 2018 PREFACE AND ACKNOWLEDGEMENTS This monograph is the result of a meeting held in Washington, DC, on July 12, 2018. It is the eighth such meeting organized by the Atarum Center for Value in Health Care, and was supported by the Robert Wood Johnson Foundation for the seventh consecutive year. We are grateful to the foundation for its continued support that has imparted continuity, visibility, and prestige to the event. Of course, the content is solely the responsibility of the authors and does not necessarily represent the views of the Robert Wood Johnson Foundation. In particular, we thank Katherine Hempstead, our Robert Wood Johnson Foundation program officer, for her guidance, wisdom, and enthusiasm. The foundation’s support of our Health Sector Economic IndicatorsSM and Health Sector Trend Reports—products that are linked to the symposium funding— stimulates us to track important developments and keep pace with emerging changes affecting the health economy. We received valuable advice guiding the entire symposium project from our colleagues Charles Roehrig, Ani Turner, George Miller and Corwin Rhyan. Superb editorial input and formatting was provided by Hendi Kowal and Tad Lee. Please note: We have edited the July 12, 2018 presentations for clarity, and have added links, some of which stem from activities occurring following the symposium. A complete (4-hour) video of the event is available at: https://altarum.org/event/ sustainable-us-health-spending-serious-issues--sound-policy-solutions. This site also contains the materials for all of our previous meetings. For any questions or comments, please contact: Paul Hughes-Cromwick [email protected] (734) 717-9539. Sustainable U.S. Health Spending: Serious Issues—Sound Policy Solutions 3 CENTER FOR VALUE IN HEALTH CARE SYMPOSIUM MONOGRAPH JULY 2018 CONTRIBUTORS Peter B. Bach is a physician, She is passionate about transforming America’s system to epidemiologist, and writer at Memorial deliver greater value to all. Sloan-Kettering Cancer Center where he is Director of the Center Connolly has spent more than a decade in health care, for Health Policy and Outcomes. His first as a national correspondent for the Washington Post research focuses on healthcare policy, and then in thought leadership roles at two international particularly as it relates to Medicare, consulting firms. She is a leading thinker in the disruptive racial disparities in cancer care quality, and lung cancer. forces shaping the health industry and has been a trusted Along with his scientific writings he is a frequent contributor adviser to c-suite executives who share her commitment to to The New York Times and other newspapers. equitable, patient-centered care. Melinda Buntin, Ph.D. is the chair She is co-author of the book “LANDMARK: The Inside of the Department of Health Policy Story of America’s Health Law and What it Means for Us at Vanderbilt University’s School of All,” has covered six presidential campaigns and numerous Medicine. She previously served as natural disasters including Hurricane Katrina. She is Deputy Assistant Director for Health the first non-physician to receive the prestigious Mayo at the Congressional Budget Office Clinic Plummer Society award for promoting deeper (CBO), where she was responsible for understanding of science and medicine and in 2001 was managing and directing studies of health care and health awarded a fellowship to Harvard’s Kennedy School of care financing issues in the Health, Retirement, and Long- Government. term analysis Division. Connolly serves on the board of Whitman-Walker Health, Prior to joining CBO, Dr. Buntin worked at the Office a $26 million non-profit, community health center, serving of the National Coordinator for Health IT, where she 15,000 clients a year. She is a founding member of Women established and directed the economic analysis, evaluation, of Impact (WOI) for Healthcare and serves on the national and modeling group, while on leave from RAND. At RAND, advisory committee of the Altarum Institute Center for Dr. Buntin served as deputy director of RAND Health’s Sustainable Health Spending. She is a graduate of Boston Economics, Financing, and Organization Program, director College. of Public Sector Initiatives for RAND Health, and co- director of the Bing Center for Health Economics. Her Douglas William Elmendorf is an research at RAND focused on insurance benefit design, American economist who is the Dean health insurance markets, provider payment, and the care and Don K. Price Professor of Public use and needs of the elderly. Policy at Harvard Kennedy School. She has an A.B. from the Woodrow Wilson School at He previously served as the Director Princeton and a Ph.D. in Health Policy with a concentration of the Congressional Budget Office in economics from Harvard University. (CBO) from 2009 to 2015. He was a Brookings Institution senior fellow from 2007 to 2009, Ceci Connolly, a nationally-recognized and briefly in 2015 following his time at the CBO, and was a health care leader, is the president and director of the Hamilton Project at Brookings. CEO of the Alliance of Community Health Plans. In her role, she works with He earned his Ph.D. and A.M. in economics from Harvard some of the most innovative executives University, where he was a National Science Foundation in the health sector to provide high- graduate fellow, and his A.B. summa cum laude from quality, evidence-based, affordable care.