Looking Back, Moving Forward

HMS Department of Health Care Policy celebrates 30 years

Barbara McNeil, the Ridley Watts Professor of Health Care Policy on stage.
Barbara McNeil, founding chair of the Harvard Medical School Department of Health Care Policy, celebrates 30 years of leadership. Image: Gretchen Ertl

In spite of recent turbulence on the path, progress toward the recognition of the human right to health care for all Americans will go on.

This was the prediction of Kathleen Sebelius, former U.S. Secretary of Health and Human Services, who led the agency during the rollout of President Barack Obama’s Affordable Care Act in 2010. Sebelius was discussing what the recent 2018 elections may mean for the future of health care in the U.S.

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“The march toward universal coverage—as slow and difficult and painful as it has been—will continue,” Sebelius said. “I’m just glad I got to play some small part in it.”

Sebelius was the keynote speaker for a symposium titled “Transforming Health Care in America: Lessons from the Affordable Care Act.” The event, held on Dec. 4 at the Joseph B. Martin Conference Center at Harvard Medical School, celebrated the 30th anniversary of the founding of the Department of Health Care Policy at HMS.

Many leaders in the field offered praise for the department’s significant contributions to improving the understanding and implementation of health care reforms.

In a letter, Obama sent his thanks and congratulations to the department.

“I want you to know how grateful I am for your steadfast commitment to our shared mission of ensuring all Americans know the peace of mind that comes with having quality, affordable health care,” Obama wrote.

Past is prologue

Barbara McNeil, the Ridley Watts Professor of Health Care Policy at HMS and founding chair of the department, opened the symposium with a brief history of health care policy at HMS and a celebration of the accomplishments in research, education and service of department faculty and alumni.

“Health care policy touches our lives in ways that have profound implications on our health, our bank accounts, the productivity of our economy, and our politics,” McNeil said.

The department, now a part of the Blavatnik Institute at HMS, was one of the first in the country embedded in a medical school. It has been a pioneer in an interdisciplinary research approach that draws on the strengths of clinicians, social scientists, statisticians (and increasingly, bioinformaticists) to understand the impacts of policy on health and to offer guidance for building better policies.

While the symposium focused on lessons learned from implementation of the ACA, which McNeil said was “arguably the most important health legislation of the last half century,” the department’s efforts affect many other areas of research, care delivery and training, including evaluations of innovative care delivery like telemedicine, research into the challenges of and potential solutions for the opioid epidemic and suicide prevention tools for veterans.

“We all share a common sense of purpose and a desire to use our skills and insights as physicians and scientists to be a force for good,” McNeil said.

Harvard University President Lawrence S. Bacow also welcomed speakers and guests and extended his congratulations to the department and to McNeil for three decades of leadership.

Bacow noted that finding a sustainable solution to the challenge of providing quality health care was crucial to society. Lauding the department’s accomplishments in this area, Bacow noted that there is still much work to be done.

“I look forward to working with all of you to make sure that we continue to make progress on some of the most important ideas of our time, to create opportunity for all and to ensure that we continue to make the world a better place,” Bacow said.

HMS Dean George Q. Daley also offered his congratulations.

“The faculty, students and alumni of the department are helping to make people healthier by informing public policy and participating in crucial dialogues on the delivery and sustainability of care,” Daley said in a video address. “The department plays an essential role in bringing evidence-based analysis to policymakers and to industry leaders.”

Attendees included hundreds of supporters and friends of the department, past and current faculty and students from Harvard, as well as leaders from other universities, the insurance industry, the hospital industry and government health policy agencies. A livestream reached more than 20,000 viewers from as far away as Austria, Egypt, Greece, Nigeria, Pakistan, the United Kingdom and Vietnam.

The symposium focused on personal reflections and research findings on several key facets of the implementation of the ACA.

Sebelius provided a behind-the-scenes analysis of how the ACA was written and launched, as well as insights into how the current political scene is shaping the legacy of the act, often referred to as “Obamacare.”

In the next few years, Sebelius said, progress that will be made in increasing access to care is likely to come in the form of experimentation in states, especially those with newly elected Democratic governors who campaigned on improving health care access, and states with referenda on expanding Medicaid under the ACA, as well as states that are moving toward universal coverage under state laws, without more help from the federal government. Sebelius said the newly elected Democratic majority in Congress should be able to prevent further efforts to repeal or replace the ACA.

Sebelius said she had expected that Republican opposition to the ACA would end in 2012 with the Supreme Court decision preserving the bulk of the law and with the reelection of Obama, but she was surprised by the “ferocity” of ongoing opposition to the ACA, which she said often seemed motivated more by political antagonism toward Obama than by real disagreements over questions of policy.

The need for evidence

The symposium also featured sessions on how the impact of the ACA was felt in the private insurance sector, in Medicaid and in efforts to change the way that health care services are paid for. Each session began with brief research presentations by HMS faculty members and colleagues.

The researchers reported on the successes and failures of different aspects of the ACA.  One common theme was the underlying complexity of the health care system, and the complicated, sometimes chaotic, nature of efforts to reform it.

Some interventions worked well in some places and poorly in others, the researchers said, while other reform efforts made a significant difference in the cost of treatment for some conditions, but not for others.

This complexity, they said, makes it unlikely that the search for a single solution that can overcome all of the obstacles to improving affordability, access and quality of care will succeed.

The presentations were followed by responses from commentators who were instrumental in the passage and implementation of the ACA, including Donald Berwick, a lecturer in the department, now a senior fellow at the Institute for Healthcare Improvement and a former administrator of the U.S. Centers for Medicare and Medicaid Services; Sherry Glied, Dean of the NYU Robert F. Wagner Graduate School of Public Service and former assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services; Jeanne Lambrew, senior fellow at the Century Foundation and former deputy assistant to the president for health policy); Cindy Mann, a partner at Manatt, Phelps & Phillips, LLP and former deputy administrator and director of the Center for Medicaid and CHIP Services; and Peter Slavin, President, Massachusetts General Hospital and HMS professor of health care policy.

A researcher’s goal is to make predictions, gather data, evaluate outcomes and present evidence, said Michael McWilliams, the Warren Alpert Foundation Professor of Health Care Policy and a professor of medicine at HMS, in his presentation on payment reform.

This goal has become increasingly challenging in the current policy climate, he said.

“Evidence is under siege,” McWilliams said. “Sometimes it feels like we are losing the battle against stories and slogans and anecdotes.”

Sebelius, who was named the 2018 Seidman Lecturer at HMS for her role at the symposium, reiterated how important the rigorous research and evaluation efforts of health care policy faculty and their colleagues at other independent research institutions were to providing the valuable insights necessary for improving health policy.

Sebelius and all the other commentators also stressed the importance of the department as a source of human capital for efforts to improve health care policy, both the faculty members participating in developing and implementing laws and those educating the next generation of leaders in health policy.

As the states try new ways to manage Medicaid and Medicare Advantage, as providers pilot new approaches to coordinated care, as advocates push to incorporate interventions that address the social determinants of health, and as American society continues to search for ways to increase quality, value, affordability and access to care, the need for thoughtful, rigorous health policy research like that produced in the Department of Health Care Policy will continue to be crucial, the speakers agreed.

“This is going to be a great time to experiment,” Sebelius said.