Obamacare “Innovation Center” Testing Method Is A Mess
I know what you’re thinking: how could an idea born from the Affordable Care Act be a problem?
(NY Times) The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade.
But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs.
But they have rarely been used to guide health care policy – and experts say the center is now squandering a crucial opportunity to develop the evidence needed to retool the nation’s troubled health care system in a period of rapid and fundamental change.
The idea, though, is to retool the supposedly trouble health care system (love how people who receive excellent care call it that) towards a government driven and government controlled system. As such, they feel no need to follow the tried and true randomized clinical trials method.
Instead, the Innovation Center has so far mostly undertaken demonstration projects; about 40 of them are now underway. Those projects test an idea, like a new payment system that might encourage better medical care – with all of a study’s participants, and then rely on mathematical modeling to judge the results.
How’s that working out?
Dr. Patrick Conway, the director of the center, defended its reliance on demonstration projects, saying they allowed researchers to evaluate programs in the real world and regularly adapt them. “Does it look like it is working?” he asked. “If it does not look like it is working, we can stop.”
He said that the center has had trouble getting such studies to yield solid results because those in the control groups – who do not get the innovation being tested – tend to drop out.
So, the director of the center defends the projects, then admits that they have trouble getting results, because those in the control groups drop out. Sound rather like Obamacare in a microcosm.