Day 3, Negotiated Rulemaking

Day 3 of the January 2011 negotiated rulemaking committee is underway. Full committee meets until Noon (with public comment at 11am). Subcommittees will then meet this afternoon to refine our work plans/tasks in preparation for the next meeting.

8:30: starting with reports from subcommittees proposing their work to be done prior to the February 2011 meeting. Basically laying out tasks that need to be completed to inform key decisions. Key areas are pros/cons of various provider data sources and especially the tradeoff between supplementing readily available data with primary collected surveys/data collection areas. Big question is how much better info for how much more local cost?

9:00: Presentation on Healthy People 2020. We have been having some discussion in the committee about choice of measures and when in doubt picking measures that overlap with other key efforts (like Healthy People 2020 targets and goals).

9:35: Marc Babitz (committee member from Utah) giving a presentation on his vision/route to completing our work. He has been the most consistent member of the committee and asking us to focus on identifying poor health status/need in prioritizing designation methods which are used to allocate resources. He has done a good job of helping us to see the big picture goal of what we are doing (easy to get lost in the weeds). It is a gift to be able to take alot of information that has been provided in many ways and to restate them in a straightforward manner.

10:00: Excellent discussion has resulted in response to Marc's presentation. The clarity of Mark's views have helped other members of the committee to clearly present their views. Very positive last 45 minutes in helping the committee think through the issues and refine their positions/views which is a necessary for us to be able to reach a consensus.

10:30: Committee member Bob Phillips presenting some of his work (much done in conjunction with/by his colleague at the Bob Graham Center Steve Pettersen) on the use of social deprivation indices to proxy poor health outcomes. They began around 8 years ago seeking to devleop a measure of poor access to primary care, but have found the measure to be fairly highly correlated with poor outcomes (like Ambulatory care sensitive conditions, diabetes prevalence, mortality, etc). There is some interest in potentially combining the use of a social-deprivation type index plus actual observed health outcomes in areas to allow for an aspect of 'fact checking on the ground' a designation approach.

Discussion of tradeoff between many variables with highest explanatory power v. more parsimonious (simple) model that explains most of the variation that a more complicated method would.

Bob has showed a conceptualization based on observed data that is useful, I think. High risk below means as measured by social deprivation index, high need means based on observed outcome measures.

• High risk, high need >>> high priority for resources
  
• Low risk, high need >>> ambiguous, need to look closer
  
• High risk, low need >>> ambiguous, need to look closer
  
• Low risk, low need >>> lower priority for resources
  

Discussion of face validity and ability to explain results and how you move it into an actual designation process.

As an aside, Alan Morgan, if you are reading, the discussion this morning is what you have been wanting! Very specific, committee members interacting and communicating well!

11:15: setting agenda for February meeting.

11:20: public comment.

2:45: subcommittees adjourned. Good meeting, progress made.