Farzad Mostashari, MD, the national health IT coordinator, said that data and analytics played a critical role in the campaign and re-election of President Barack Obama – mirroring the growing importance of data in healthcare.
Data and analytics have transformed marketing, campaigning, and even baseball. “How is it possible for us to imagine a world where that power of data is not brought to bear on life and death, clinical care, on population health, and affirming the path that we are on with health IT and bringing data to life?” Mostashari said in comments about his thoughts the morning after the election at the Nov. 7 meeting of the federal advisory Health IT Policy Committee.
During the campaign, the analysis of surveys, polls and computer models drew considerable discussion about whether they were going to bear out their findings and be accurate, or not.
[Political Malpractice commentary: Don't pop the champagne for ACA anytime soon]
“It was something of a relief that data matters, that science matters, that predictions can be based on evidence,” he said, adding that there was also “relief in seeing a truce in data.”
“We sometimes see this in our corner of the world, where the preponderance of the evidence, the 92 percent of studies, can be positive and show benefits, but if there is uncertainty and differences,” others can play up a narrative of opposing realities, Mostashari said.
The election outcome gives the administration more time to finish the job, building on the “incredible progress in the past four years on health IT.”
“In my view, it gives us the chance to continue to make strides, continue the essential thrust of the policies and the approaches. But it also affirms our responsibility to do the peoples’ work, to come together, Republicans and Democrats, to do the peoples’ work,” he said.
Mostashari cited the work of the policy committee, appointed by Republicans and Democrats, with stakeholders from patient advocates, doctors, hospitals, payers, researchers, and vendors, coming together to focus on challenges that can only be solved together and “committed to the painstaking work of building consensus.”
“Progress has always been through fits and starts. It has not always been a straight line, a smooth path. We need to keep reaching, keep working, keep fighting, and take the time to look afresh at what we’re doing,” he said.
With that in mind, he brought the committee back to its work at hand for meaningful use and asked “whether we are pushing hard enough on interoperability and whether there is more that we can do, whether it’s around query-based exchange and the cluster of identity matching and patient consent, to ensure that we are pushing hard enough and fast enough in terms of the privacy and security that must accompany the creation, availability and greater flow of information, whether it’s around two-factor authentication, audits and consent, management for sensitive information,” he said.
Mostashari was not the only expert to comment on the value of data. Thomas Mann, senior fellow in governance studies at the Brookings Institution, also said that a big winner in this election was “anyone who believes in real data, of evidence. It’s really encouraging,” he said at a post-election briefing.
He anticipates that healthcare reform, the Patient Protection and Affordable Care Act (ACA) “will be seen historically as the signal achievement of the Obama administration and will ultimately lead to both improvements in quality and delivery but control the costs in a way that goes to the cost drivers and not involved in a series of cost shifting and prayers about what new competition can do in this arena. I think it’s very significant and promising but difficult,” Mann said.
Isabel Sawhill, co-director of Brookings’ Budgeting for National Priorities, Center on Children and Families, saw plenty of hurdles ahead. She believes that ACA implementation is going to be enormously difficult because of the number of Republican governors who do not support it.
“It would be hard enough to do this if everyone were enthusiastic. Doing it without full support is going to take a miracle for it to work. I think it needs a second look. One element of a grand compromise could be to take a second look,” she said.
Barely half of the public supports healthcare reform, she said, adding that she could imagine a scenario in which over time more and more people move on to the exchanges, and the U.S. ends up with a system similar to single payer structures in Europe.
“But in the short term, I am very pessimistic, and I don’t think there was enough done to control long-term costs,” Sawhill said.
Mann said he was more optimistic based on the level of innovation already taking place within states, major health providers, and Medicare and Medicaid.
“I think the ACA help set in motion, through the last 500 pages of the bill, all the experiments and incentives for fundamentally changing the way in which health care is delivered and reimbursed,” he said.
[Political Malpractice slideshow: Readers views' on healthcare in the elections]
A crucial part is getting people insured, and there has been headway made. “Once you cross the threshold, and people are insured and protected for a period of time, if you try to take that away, you are in deep trouble. The one thing we’ve learned is the power of path dependence, or courses taken, if sustained for a period of time, come to redefine the new status quo,” Mann said.
He has no doubt, however, that aspects of ACA will be restructured again and again.
Sawhill suggested a system in which the core of the working-age population continues to obtain private insurance through an employer, but with more and more people having access to exchanges and a public option. For seniors, over time there would still be the option to have traditional Medicare but also an alternative that is now called premium support.
Eventually, the two systems will become integrated, divided by whether an individual is over or under age 65. Private insurance companies would still provide plans that people can select for the working age and the elderly. But they would have an option for a public plan as well.
“And then we let the two sides, the public and the private," Sawhill said, "duke it out on who can do it better.”
