HCP Faculty Song and Zubizarreta Explore Policy Issues in Health Care at NASEM Spring Meeting

The National Academies of Sciences, Engineering, and Medicine (NASEM) Board on Health Care Services (HCS) held its Spring Meeting last week in Washington DC. This year’s meeting featured two HCP faculty, Zirui Song and José Zubizarreta, addressing the critical topics of private equity in health care and causal inference in observational studies.

The day kicked off with a focus on private equity's role in health care. Song reviewed the evidence on private equity acquisitions of hospitals, physician practices, and other health care providers. Vivian Ho, from Rice University and Baylor College of Medicine, presented on the effects of consolidation in health care on prices and quality. 

The afternoon moved to the National Institute on Aging (NIA) sessions, titled "Improving Measurement and Data Quality in AD/ADRD Research." These sessions featured presentations by Zubizarreta, F. DuBois Bowman, University of Michigan, Rebecca Hubbard, University of Pennsylvania, Elizabeth A. Stuart, Johns Hopkins University, and Julian Wolfson, University of Minnesota School of Public Health.

Song’s opening presentation, Private Equity in Health Care: A Policy Framework, highlighted the growth in private equity acquisitions of health care providers and focused on a set of policy responses considered by state and federal policymakers. Private equity acquisitions, often financed with substantial debt, have been observed in hospitals, nursing homes, and increasingly, physician practices, along with other sectors of the delivery system. Evidence has linked such acquisitions to increased prices and volume of services, along with reductions in clinician staffing and quality of care. 

While private equity acquisitions can provide needed capital for health care facilities, the subsequent staffing reductions and patient harm are consequential tradeoffs that have garnered scrutiny by policymakers and the clinician community. This discussion on private equity was situated as part of a larger conversation about the commercialization of health care and the prioritization of patient well-being in the context of financial interests. 

Song’s most recent study in Health Affairs on this topic addresses policy responses in more depth, including a review of policy efforts in several states and other countries.

Zubizarreta's presentation began the afternoon NIA Session: Improving Measurement and Data Quality in AD/ADRD Research. In his presentation, A Framework to Establish Causation Beyond Association in Observational Studies, he discussed key methods to go from association to causation in observational heath care studies. 

Zubizarreta emphasized the role of design in observational studies, and discussed to what extent matching, regression, and weighting methods approximate critical features of randomized experiments in observational studies. His talk further examined widespread event study designs in health care research, illuminating how well traditional regression approaches build a causal contrast in observational data from an experimental design standpoint.

Both Song and Zubizarreta emphasized the importance of this research for health care policy and practice. Song stated: “It was a privilege to present with José, Liz Stuart, and other great colleagues in the field. The work on private equity represented the collective effort of many scholars over recent years, and it was an honor to share that research with the Board on Health Care Services at NASEM.”  

Zubizarreta shared this sentiment and highlighted the potential of innovation advocacy in the research realm: “Presenting at the Board on Health Care Services at the National Academies of Sciences, Engineering, and Medicine (NASEM) provides a unique opportunity to bridge the gap between cutting-edge data science innovations and a broad spectrum of influential health care research endeavors. The Members of the Board, who are leaders in their respective fields, can advocate for improved research methodologies based on the work presented. Sharing our research can significantly enhance health care studies by providing them with robust and transparent methods to establish causality.”

The HCS Board plays a vital role in shaping healthcare policy, focusing on areas like organization, financing, workforce, and delivery, with an emphasis on quality, cost, and accessibility of care. This year’s meeting demonstrated that with their experienced staff and commitment to actionable advice, the HCS continues to make significant contributions to the future of healthcare in the United States and abroad.