Advancing Research in the Era of Healthcare Reform: The 19th Annual HMO Research Network Conference, April 16-18, 2013, San Francisco, California

Abstract

Healthcare system transformation has pursued higher quality, more affordable healthcare from the popularization of health maintenance organizations (HMOs) in the 1970s, through the innovations in structure and management of the 1990s, to the current-day challenge of extending healthcare coverage to previously uninsured groups as partially conceptualized in the Patient Protection and Affordable Care Act (PPACA) toward Accountable Care Organizations (ACOs). Census 2010 reported that 17% of Americans had no insurance whatsoever, 18% were publicly insured,1 and the remaining 65% were privately insured. Overall, approximately 1 in 4 Americans is enrolled in an HMO, including Medicare HMO options. Research on persons covered by managed care insurance and integrated delivery systems is needed to round out our understanding of how people use healthcare and how their health status relates to that usage. These are the middle class Americans, the working well, who are not well represented in federal programs. Groups commonly examined by health services researchers include Medicaid beneficiaries (impoverished, mostly children), Medicare beneficiaries (older or disabled persons), and Veteran’s Administration patients (disabled, impoverished, tied to military recruitment trends, mostly male). Other major sources of health data are primarily survey-based (such as the National Ambulatory Medical Care Survey on outpatient care) or topically focused (Surveillance Epidemiology and End Results on cancer, Health Cost and Utilization Project on inpatient experiences) and therefore lacking in comprehensiveness and in detail regarding specific procedures, medications, and diagnoses received. These factors—population and data quality—spurred the development of the HMO Research Network (HMORN) and its Virtual Data Warehouse (VDW), a clinical records-based data resource on insured persons. Now in its 19th year, the HMORN held its annual meeting in San Francisco, April 16–18, 2013, hosted by Kaiser Permanente of Northern California with Dr. Alan Go as Chair. We are now in the era of healthcare reform. Cost containment continues to pressure development of efficient care delivery and payment structures, with quality of care and patient experience as equal goals in the “Triple Aim”.2 In the past two years, changes enacted via the American Recovery and Reinvestment Act-funded Health Information Technology for Economic and Clinical Health electronic medical records adoption mandate (beginning in 2011), expansion initiatives for Medicaid, rural and other underserved populations (as of March 2012), and economic market forces, in general, have continued to shape both clientele-served and cost reimbursement schemas. This evolution has led healthcare systems to ask, why do people come through our doors? Who chooses not to return? What do we have to do as a system to provide high quality care at a sustainable price, engendering excellent patient satisfaction? These challenges informed the theme of the 2013 HMO Research Network Conference, “Advancing Research in the Era of Healthcare Reform.”