Peter Neumann, ScD - Director of the Center for the Evaluation of Value and Risk in Health (CEVR)
Research Vision/Mission
The overall goal is to improve population health for the dollars and resources spent. This mission can take us to a lot of areas. It’s always a mix between what can we do to address that goal and what do people want us to do. We have a big database of cost effectiveness analyses that provides a window into that question: how can we improve population health given the resources available?
What do you enjoy the most about your work?
I always find it intellectually engaging and challenging. We work on real world problems, and I like working with people who have real problems that we can help address. We’re academics, but we always try to be relevant. There’s never a shortage of problems to work on.
What impact do you see your work having on the future of the healthcare landscape?
We hope to help policy makers, payers, and other decision makers as they address questions such as whether and how they should pay for new technologies: If so, how much? And for whom? These are both clinical and economic question. Similar questions could include: Will the treatment or technology provide reasonable value for the money? If an improved technology appears, will it change current management strategies? What’s the alternative if we don’t pay for this technology? Is the current workup sufficient?
We often build models to help decision makers think about these questions – for example imaging for Alzheimer’s screenings and new lung cancer screenings. We want to help people think about resource allocation decisions.
How do you see the relationship between your research and medicine evolving in the future?
There are always big gaps in the evidence base that need to be filled through clinical trials, analyses of databases, etc. When we hire new people, we’re looking for individuals who are facile with big databases as we’re getting more and more information on patients as they travel through the [clinical] process. We’re marrying clinical data with payment data that are produced when patients go into the medical system. In the future, we will also have better information on genetics that we can use to link to existing clinical data.
Given the direction of healthcare, do you think that health economics is becoming more important? Or have you had to change direction [of your research] with the way healthcare is going?
It becomes more important over time, as spending continues to increase rapidly (faster than the overall economy). Health spend increases at a faster rate than overall spend, so the share of economy that goes to health keeps going up. By having healthcare become a bigger portion of our economic spending, it means that we have fewer resources to allocate towards education, housing, etc. So yes, health economics is becoming more important. As far as whether or not it’s changed my direction, I don’t know. There’s a lot of demand in this work since we’re in the space of measuring value. There’s a lot of work to be done, and there’s consistently been a strong demand for it.
You mentioned that we keep spending on health and thereby less on education, but education and social determinants of health affect healthcare. How much of your research is based on social determinants and how that relates to healthcare spending?
If the goal is to improve population health through spending, we should think about all the different strategies at our disposal to improve health. Many of them are not medical care [but are] public health strategies or non-health strategies. We do think about it, but probably not enough. One of the challenges is that data on these topics are often not as good. Pharmaceutical companies have good data because of the rigorous regulatory processes they have to go through. Education is a way to improve health, but we need to have data on the impact of programs. Sometimes we do, but often we do not. The funders we go to often don’t think about those types of strategies. Sometimes the funding follows the diseases, like cancer and HIV or the treatments like pharmaceuticals.
Research institutes are usually compartmentalized based on disease and not on factors like social determinants. If you look at the burden of disease versus funding or versus cost effectiveness analyses, you tend to find over-studied areas. All these diseases are important, but some do receive relatively more funding given the burden (breast cancer, HIV, etc.). Injuries on the other hand have a huge burden, but not as much funding. It’s the same with some of the government’s own priority areas/goals (Healthy People 2020). These priority areas are areas in which the government is looking to improve health, usually on things we don’t do enough of. The government puts out goals of things we should be doing, and those are in areas that don’t traditionally have a lot of cost effectiveness analyses. For example, areas like; mental health, STI’s, population health, etc.
How did you end up in this field and what motivated you to do what you’re doing?
Like many people, I took this unexpected path with a lot of twists and turns. I started off in economics and my first job was in Washington in tax policy on Capitol Hill. I wasn’t involved in health at the time. Then I started working on some health issues in the 1980s – even then, we were starting to worry about our spending on healthcare. So, I started to get interested in the economics of healthcare and went back to do my doctorate at the school of public health at Harvard. Then I went back to Washington to work on policy issues. I ended up back in Boston, and to my surprise, I ended up as an academic. I thought I would be doing policy work but I started writing, researching, and publishing, and here I am. I think most people land in a job and find aspects that are interesting. I think for everyone the key is to find interesting questions to pursue and to build on what’s been done.
Advice for future medical professionals?
In addition to all the good clinical training you’ll receive, training in quantitative data science such as statistics, epidemiology, and perhaps programming and decision science would be important in helping you think through problem solving in health. Behavioral and social sciences, such as economics and psychology, are helping us understand how people behave, not just in medicine. The current treatment model is often to tell people to take medication, stick to a diet, exercise, etc. The problem is that people don’t do those things very easily, and why they don’t do them is complicated. How to get them to do it is even more complicated. The way to get them to do it is not to be paternalistic about it, but to understand why they’re not doing it, along with the technology and financial incentives. Knowing economic, behavioral, and data science could help inform an understanding around these human factors.