The U.S. Government Accountability Office (GAO) released a study on July 26 entitled, “Value in Heath Care – Key Information for Policymakers to Assess Efforts to Improve Quality While Reducing Costs.” This study was conducted at the request of Senator Kent Conrad (D-North Dakota), Chairman of the Senate Budget Committee, over the period April 2009 – July 2011. It is relevant to policymakers and analysts at all levels of government as well as managed care and provider organizations.
GAO notes that overall health care spending in the United States rose from 7 percent of the gross domestic product ($306 billion) in 1970 to 16 percent of GDP ($2.2 trillion) in 2008; federal health care spending rose from 10.5 percent of the federal budget in 1970 to 32.6 percent of the federal budget in 2008; and high levels of health care spending do not guarantee high quality of care. The Centers for Medicare and Medicaid Services (CMS) released estimates on July 28 showing that overall health care spending will reach 19.8 percent of GDP ($4.6 trillion) by 2020.
Facing this challenge, Federal, state, local government, and private sector health care analysts have long sought evidence-based intervention strategies to increase the value of health care, improve quality, and control costs. The GAO report categorizes those strategies generally as payment reform, insurance redesign, chronic care management, patient safety improvement, care coordination/transition, preventive care, system improvement, and process of care improvement. The GAO identified 239 specific interventions on which research evidence was available and assessed the credibility of the evidence in terms of social science research principles on research design, statistical methods, gauging the results of “pilot” projects, etc. The GAO also drew upon a vast inventory of published research literature, the federal Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange (HCIE) database, Tufts Medical Center’s Cost-Effectiveness Analysis (CEA) Registry, and replies to GAO questionnaires by researchers on 127 of the 239 interventions. GAO concluded that many of the available research studies did not include rigorous designs sufficient to isolate the effect of the intervention strategy from other factors.
The GAO report offers constructive suggestions to help policymakers and the analysts who support them to assess the strengths and limitations of research evidence pertinent to their work. It also offers the results of GAO questionnaires on variables driving the success of intervention strategies, such as the active engagement of organizational leadership, an organizational culture that encourages innovation, staff resources, financial resources, financial incentives, and information technology. GAO concluded that financial incentives are important in the implementation of payment reform and insurance redesign strategies while inter-operative health information technology is critical in cross-provider strategies such as improving care coordination/transition. GAO’s “Value in Health Care” report (GAO-11-445) is available at www.gao.gov.
