How Modeling Can Inform Strategies to Improve Population Health Workshop Summary (2016) / Chapter Skim
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3 Case Studies of Models Used to Inform Health Policy
3 Case Studies of Models Used to Inform Health Policy
Pages 19-38
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From page 19... ...
Bobby Milstein, a director at ReThink Health, illustrated how communities have used models to engage in regional health reform efforts. An open discussion moderated by Russo followed the three presentations.
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From page 20... ...
• Modeling suggests that a balanced approach to regional health reform, with investments in both downstream and upstream interventions, may be more costly in the short term but that it is the only way to generate increasingly greater returns over time in terms of lower health care costs, fewer premature deaths, greater equity, and stronger economic productivity. (Milstein)
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From page 21... ...
• What is the estimated impact of tobacco control policies on avoided mortality? One of the issues that Mendez has been exploring using the ichigan M Model of Smoking Prevalence and Health Effects is the effect that tobacco control policies have on the smoking status of individuals.
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From page 22... ...
Similarly, water flowing out of the bathtub represents individuals who quit smoking plus the number of people who die from all causes. The level of water in the bathtub represents smoking prevalence, and this is what he and his colleagues are interested in and what the model tracks over time.
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From page 23... ...
Figure 3-4 R02894 To understand the health effects of smoking, Mendez and his colleagues used data from theraster uneditable Study II to develop relative Cancer Prevention risks for former and current smokers, both female and male. The model predicts the relative risk of death from the time of smoking initiation and the length of time an individual smoked.
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From page 24... ...
Mendez listed some of the ways in which he and his colleagues have used this model. These included assessing smoking prevalence targets, evaluating the effect of offering smoking cessation programs in managed care organizations, evaluating the impact of menthol cigarettes on a population's health, evaluating the effectiveness of radon remediation when smoking rates are declining, and evaluating the effect of tobacco control policies on global smoking trends.
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From page 25... ...
. To evaluate the potential impact of tobacco control policies on global smoking trends, Mendez and his colleagues used data from World Health Organization databases and explored what would happen with the world prevalence of smoking if current conditions continued compared to an environment in which a comprehensive package of well-known effective tobacco control strategies was implemented.
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From page 26... ...
adult smoking prevalence under status quo and California smoking initiation and cessation rates. SOURCES: Mendez and Warner, 2008; Mendez presentation, April 9, 2015 that removing menthol cigarettes from the market would benefit public health.
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From page 27... ...
. DEFENDING PUBLIC HEALTH MODELS IN THE COURTROOM Pasky Pascual started his presentation by talking briefly about a model ng technique that he has used, called hierarchical Bayesian model i ing, to investigate the relationship between charged particles and oxygen in two streams just north of Washington, DC.
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From page 28... ...
Pascual and his colleagues used the FDA Reauthorization Act to make the case that models used for regulatory decision making need to be transparent in terms of both the methods used and the epi stemic framework of those methods. In an upcoming paper, Pascual and his collaborators discuss how model transparency leads to both legal accountability and defensibility in the context of the Clean Air Act.
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From page 29... ...
MODELING REGIONAL HEALTH REFORM USING THE RETHINK HEALTH DYNAMICS MODEL Health data show that there are regional patterns that transcend the specifics of any disease or physical exposure, said Bobby Milstein, and this is true for the way that health care is delivered and how much it costs and with regard to the social, economic, and environmental conditions that leave people vulnerable to risk and disease. The challenge of addressing health reform at a regional level is what drove Milstein and his colleagues at ReThink Health to develop a model that can be used by those working to address health reform at the regional level to ask questions about the likely health and economic consequences of their efforts under realistic regional conditions that account for local trends related to a wide range of factors.
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From page 30... ...
. For example, planners can focus on actions to cut health care costs, improve quality, or expand capacity as well as wider efforts to enable healthier behaviors, reduce environmental hazards, improve public safety, and expand socioeconomic opportunities that strongly shape health and well-being while also affecting the demand for expensive downstream health care.
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This3-8 Figure approach begins with an assumption, which can be easily varied, that start-up funds are available from a R02894 temporary innovation fund set at 1 percent of total health care spending raster uneditable for just 5 years. Also, it assumes that half of any savings that accrue from lower health care costs will be reinvested in the endeavor, which is similar to what many accountable care organizations are doing; furthermore, it is assumed that there will be a shift in provider payment away from feefor-service to per capita payment.
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puters to play this out against the other3-9 Figure changing dynamics in a region," said Milstein. R02894 A second scenario tested a more balanced approach, with those same two images, upstream investments to downstream components now coupled with enable healthier behaviors and saferuneditable each raster environments.
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From page 33... ...
Milstein claimed that with health care costs on track to grow even larger, many regions may not be able to afford not to make these cost-saving investments. In one scenario, for example, although downstream investments save nearly $1 billion, when combined with upstream investments funded by gain-sharing agreements, the savings are 50 percent greater (see Figure 3-11)
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From page 34... ...
One of Milstein's biggest priorities is to guard against two extremes that are fraught with peril: an overreliance on an imperfect model versus an under-reliance on analytical tools to compensate for known flaws in people's mental models. Decisions made in the absence of a credible model essentially depend on people's ability to think through the complexity of a vast health system, which turns out to be notoriously difficult, if not impossible.
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From page 35... ...
On the other hand, almost every modeling study using surrogate outcomes predicts that there should be positive effects. Both the modelers and the researchers carrying out the trials then claim that the other approach is wrong because it is too simplistic.
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Pasqual noted that hierarchical Bayesian approaches are particularly useful for better understanding how subpopulations fit into the larger general population. Marc Gourevitch from the New York University School of Medicine asked Milstein how the ReThink Health model makes predictions in the aggregate over time.
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From page 37... ...
Mendez replied that one of the important data gaps in tobacco control concerns how people transmit smoking behavior and how people communicate their intent to quit or to engage in smoking. "These social networks are becoming more and more important in order to study this area of tobacco control," Mendez said.
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From page 38... ...
Patrice Pascual from the Children's Dental Health Project spoke of a recent modeling project she was involved in that examined ways of reducing cavities early in childhood. Those running the project dealt with the political ramifications of the model's findings by taking those results to the community and letting the members of the community think about the political ramifications of the different pathways the community might take to achieving a goal.
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