On Friday, Oct. 7, the Institute of Medicine plans to release its essential health benefits report – those are the benefits that plans for individuals and small businesses will have to cover per the Patient Protection and Affordable Care Act.
The benefits fall under 10 general categories including emergency services, behavioral health treatment, preventive services and chronic disease management.
There may be a bit of confusion about what IoM’s task is: It isn’t defining the benefits – it is producing some methodology that the U.S. Department of Health and Human Services can use when it defines the benefits (which will generate all kinds of stories, with outrage/glee from assorted disease advocates, drug makers, medical groups, etc., not to mention another round of debate about government role in determining such things and maybe some good reporting about the evidence base for decision-making.)
Anyhow, the IoM had some preliminary meetings, naturally, and in August it published a summary of one of its workshops. It gives an interesting glimpse into what the experts are weighing and thinking about as you prepare to cover this issue in the coming months (and it will also generate some stories about what states are going to do about their insurance coverage mandates, if they aren’t wrapped into essential benefits)
Here’s the two-page version of the workshop summary. Probably no reason to read the whole report as it’s going to be overtaken in a couple of days, but if you are interested in the path the IoM took, here’s the link.
- Balancing generosity and affordability – the package needs to be comprehensive but not ridiculously expensive.
- How to define a “typical” employer plan-the starting point for EHB determinations.
- Which state mandates to include (States can maintain those rules even if not in federal EHB but they have to pay costs in subsidized programs)
- Specificity versus flexibility in the guidelines (how much plans/states can differ and still be roughly comparable)
- Determining medical necessity – and how to apply it to individual patients. But also setting rules in ways that don’t discourage innovation and progress.
- Protecting patients – i.e. making sure that people get what they need even if they are old, sick, disabled, etc. (My translation, not the IoM’s words: no fuel for another round of “death panel” charges).
- Ensuring fair processes – “public engagement, independence of decision makers, and transparency of information used”
The report is embargoed until 12:01 a.m. EDT on Friday, Oct. 7, but reporters can get an advance copy after 2 p.m. EDT on Thursday, Oct. 6. Members of the committee will discuss their findings and recommendations in a briefing at 11 a.m. EDT on Friday. The briefing will be webcast and questions can be submitted via a link on the National Academies website.
To get the report in advance, arrange interviews with committee members, or register to attend the public briefing, contact the National Academies’ Office of News and Public Information at 202-334-2138 or news@nas.edu.
