State health officials crowded into a NASHP annual health policy conference room recently to discuss how to identify and use evidence to inform policymaking in their home states. The day-long conference, entitled Using Evidence to Inform Policymaking and supported by the Patient-Centered Outcomes Research Institute (PCORI), explored the challenges state leaders face as they work to apply data and research to craft evidence-based policies.
Some of the barriers they identified include:
- States need help harnessing the power of their own data. For example, officials need assistance using state data effectively to identify the social determinants of health that are fueling the opioid epidemic in order to implement evidence-based, prevention and treatment initiatives.
- Officials are often called upon to make timely or deadline-driven decisions in the absence of strong evidence. They may also face a climate in which political or financial issues limit their application of evidence to policymaking, especially for pressing issues.
- Evidence-informed policymaking raises equity issues when evidence is based on research conducted only on majority populations. Underserved and minority populations may not be fairly represented by the body of research on which decisions are based.
- Some evidence-based policies or programs may require significant investments of time and resources in order to adequately implement them. One example is supportive housing programs that require training and coordinating staff and/or contractors in multiple roles as well as designing and implementing supportive social services.
- Multiple agencies within a state may be pursuing evidence-based approaches to the same policy issue without being aware of their common interest. For example, several treatment, prevention, and law enforcement efforts may be addressing the opioid epidemic across siloes rather than through a collaborative effort.
- Even when research is available, officials may lack the resources to access it. PubMed searches for research may yield references to informative publications in proprietary journals with costly subscription fees, which an agency cannot afford and is unable to access or benefit from.
- Effectively engaging consumers and patients in evidence-based policymaking requires resources to reimburse them for their time and effort. To ensure evidence-based policymaking that captures comprehensive community input, there should be more than just one consumer representative participating.
To address some of these challenges, state officials shared several resources and strategies they have developed to generate more effective and resource-efficient, evidence-informed policymaking:
- Take small steps to increase capacity for evidence-informed policymaking. A large scale, legislatively-mandated effort like Oregon’s Health Evidence Review Commission is not the only option. States can also take targeted approaches to collaborate across state agencies to focus on shared policy issues.
- Promote cross-agency collaboration. Colorado helped create bridges across agencies by organizing a series of informal, inter-agency in-services to give multiple agencies (Medicaid, public health, and behavioral health) an opportunity to share how they engage with evidence and select high-priority topics. These in-services can create the foundation for broader discussions of cross-agency plans to advance evidence-informed policymaking in the state.
- Maximize existing resources. For example, states can join The Medicaid Evidence-based Decisions Project (MED), which is a multi-state collaborative that produces reports and tools for policymakers. MED reports can be shared across agencies within member states, and research topics can be proposed. For example, Alabama’s CHIP program recently put forward a request for a MED report on follow-up after mental health hospitalization for adolescents.
- State university academic partnerships can be invaluable in helping to advance evidence-informed policymaking. The State-University Partnership Learning Network is one resource for helping to develop these partnerships. The State Health Data Access Assistance Center also provides helpful resources such as State Health Compare, which allows states to compare themselves with others across a range of indicators. Academic partners may also share journal subscriptions with state agency partners.
- Medicaid consumer advisory boards, which are required in each state, may be a ready resource to tap into to engage consumer voices. Procurement policies may also be used as levers for greater consumer engagement. For example, Massachusetts’ Department of Mental Health now requires bidders to demonstrate a plan for the engagement of people who will be directly served in their proposals.
- Implementation that generates evidence development is an option where evidence is lacking or incomplete. This approach entails rolling out a new program in tandem with robust evaluation efforts to determine if it is performing as anticipated.
During the conference, research organizations shared findings from new and emerging studies that have implications for state health policymakers. For example, the Center for Evidence-based Policy (CEbP) shared new research on non-pharmacological approaches to the treatment of back pain (to avoid treatment with addictive painkillers) as well as effective interventions to promote smoking cessation in pregnant women. PCORI is poised to disseminate results from over 145 patient-centered outcomes research studies in the next year and shared some highlights, including research on community health workers and effective oversight of antipsychotic use in foster children.
States are often inundated with requests to change health insurance coverage policies based on emerging evidence from a variety of sources. When this occurs, CEbP advised policymakers to first assess the research’s objectivity:
- Are there any conflicts of interest?
- Is the study consistent with the wider body of scientific literature?
- How replicable are the results?
For additional information, view the presentation slides from the presentations and NASHP’s April 2017 brief, Lessons from States on Advancing Evidence-based State Health Policymaking for the Effective Stewardship of Healthcare Resources.
NASHP is currently convening a workgroup of state official to explore the policy implications of emerging research in more depth. For questions or comments on this blog, contact Jennifer Reck at firstname.lastname@example.org.