Associate Professor, Health Management and Policy
September 20, 2017, Faculty, Health Management and Policy, Aging, Health Care Policy
The United States spends more on health care than any other developed country, yet the quality of health care and life expectancy in the US are well below its peer nations. That discrepancy is the impetus for Andrew Ryan's research.
"There's this idea that you get what you pay for--and that the high cost of health care in this country means people are getting the best possible care," says Ryan, an associate professor of health management and policy at the University of Michigan School of Public Health. "Over the past couple decades, evidence has emerged to show that that's not actually the case."
In addition, high health care spending in this country has become a social problem for a number of reasons, Ryan explains.
"First, it takes a heavy toll on Medicare and Medicaid," he says. "On the private side, the high rates of spending cause high premiums and high cost sharing. These have negative consequences for people financially and also on the quality of the health care they receive."
Encouraging high-quality, low-cost care
Ryan's research focuses primarily on value-based payment models, or payment structures that incentivize health care providers, such as doctors, hospitals, and health systems, to provide high-quality, low-cost care. Specifically, he wants to better understand how well these programs are working, whether there are specific features that are responsible for their successes and failures, and whether certain types of clinicians or provider groups are better able to thrive or more likely to fail under these payment models.
"High spending and sub-optimal quality led to the push for health care reform," Ryan says. "A big focus of reform is on payment policy. There has been lots of effort to reform how providers are paid in order to improve value by reducing spending or increasing quality--hopefully both at the same time."
But that's no easy task. Doctors and other clinicians work in a complicated structure, and they are motivated by and respond to many different factors. While doctors are invested in providing high quality care to their patients, some tasks (like performing a technically excellent surgery) are more rewarding and financially beneficial than others (like following up with an outpatient physician to troubleshoot a potential complication). Payment programs need to be developed in a way that doesn't fight against their professional norms and the ecosystem in which they practice, Ryan says.
Balancing policy and politics
The current political climate and uncertainty around health care policy isn't making the work Ryan and his colleagues do any easier. Still, he remains confident in the value of his research.
"It's immensely frustrating," he says, referring to watching the health care debate play out in Washington. "But health care reform was made possible by health care policy research. Massachusetts had a successful policy that had been studied, and that model was the basis for the Affordable Care Act. That didn't just happen. It happened as a result of groundwork that had been put in by researchers over the years.
"It's easy to get frustrated and want to throw in the towel, but the implications of doing so would be extremely negative for society. High spending is related to high rates of uninsurance and medical-related bankruptcy. I know this work is important."
Making reach more effective--and fun
Ryan leads the Center for Evaluating Health Reform at Michigan Public Health, where he and his colleagues work to advance knowledge about health system reform through improving the academic research process.
Using innovative team processes based on design theory, they produce grants and research papers--a process that typically takes weeks or even months--in a matter of days. During grant and paper sprints, they get all the key people together in one room and follow a structured agenda with a series of timed activities. At the end of two four-hour sessions, they have something that "isn't quite final but looks a lot like a grant or paper," Ryan says.
"Our emphasis is on improving the research process," he says. "We want to figure out how we do research better, so it's as efficient and effective--and fun--as it should be."