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Thursday, December 18, 2014

Best of 2014: Transparency and Evidence in Health System Reform

Caitlin Morris

Director of Affordability Initiatives

We asked our policy experts to share their picks for 2014’s must-read—or, in some cases, must-see—articles, reports, videos, and more. Today, Caitlin Morris of our Health System Transformation team kicks off the series. See more best of” lists from our teams working on marketplace health insurance and enrollment.

In large part, 2014 was about demonstrating that a commitment to transparency and good medical evidence can improve health care. Part of that involves acknowledging our own shortcomings as we seek to transform the health care system. The Guardian recently printed an edited version of the 2014 BBC Reith lecture by Atul Gawande, in which he nicely summed up one of the key challenges of our health system: “…the story of medicine is the story of how we deal with the incompleteness of our knowledge and the fallibility of our skills.” This lecture is a refreshingly frank take on the limits of what we can know. It underscores the importance of a broad movement toward evidence-based health care. As we work to transform our health care system in the coming year and beyond, we look to evidence-based care to help us focus on what we do know, and getting that right.

When it comes to health care, choosing wisely can save time and money and keep you safe

Speaking of evidence-based health care: I’m especially fond of this video James McCormack created called "Choosing Wisely." It’s a good reminder—set to the year’s most ubiquitous tune—that sometimes less is more, especially in health care. And, if you needed more evidence that Pharrell’s “Happy” really was everywhere this year, look no farther.

As consumers in 2015 grapple with understanding how their health insurance works, this video can help them see the value of fewer unnecessary tests and procedures, and more of the right care at the right time. 

Transparency is key to helping doctors, health care consumers, and policymakers make decisions

This year was also about shining a light on information that can help doctors, patients, and policymakers make better decisions about care. A beta version of the CMS Open Payments website went live this year making transparent the often-complex (and potentially inappropriate) financial ties between medical providers and the drug and device industries. In 2015 and beyond, this tool will be important in the effort improve transparency of financial relationships that can influence care decisions and identify potential conflicts of interest. 

HHS proposes researchers disclose their clinic trial results in effort to increase transparency 

Continuing in the transparency vein, HHS recently announced a proposal that will require researchers to report results from clinical trials, regardless of the outcome. The care we receive stems from medical evidence, and clinical trials are critical to determining what works in health care and for whom. But guess what? Researchers aren’t currently required to report their findings. In fact, there’s documented evidence that some researchers have suppressed negative results leaving the patients and providers with only half the story. Both Vox and Newsweek examined this issue and made the same general point: Hidden or incomplete clinical trial data can harm patients. Care should be based on the best available evidence, which requires all the evidence be available. The HHS proposal moves us a huge step forward, and we look forward to greater accountability for medical research in 2015. 

Health care policies must reflect evidence

This has also been a year of much-needed critical review of some popular—but not evidence-based— strategies to drive health improvements and control costs. Wellness programs perhaps were the most prominent. The New York Times article, “Do Workplace Wellness Programs Work? Usually Not,” does a great job of setting the facts straight about the limitations and potential discriminatory dangers of wellness programs, despite their growing popularity among employers. Such reviews highlight that—even when there is evidence of what does or doesn't work—there is still work to be done in 2015 and beyond to make sure policies and practices reflect the evidence. 

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