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IOM Committee Issues Essential Health Benefits Report

OCTOBER 11, 2011—The committee of the Institute of Medicine (IOM) charged with developing basic policy, criteria, and methods for defining and updating the package of essential health benefits (EHB) as part of federal health care reform released its report on Oct. 7, 2011. Law School Associate Professor Amy Monahan served on the 18-member committee, which researched and wrote the report "Essential Health Benefits: Balancing Coverage and Cost."

Chaired by John R. Ball, retired executive VP of the American Society for Clinical Pathology, the IOM committee included representatives of insurance companies, clinical medicine, hospital administration, legal and medical education, consumer agencies, and more. It described its primary task as finding the right balance between broad coverage and affordability, and used four foundational principles for its policy recommendations: economics, ethics, population health, and evidence-based practice.

Among recommendations in the IOM’s 300-page report:

  • Define the essential health benefits against a premium target.
  • Put in place a framework and procedures to gather the data necessary to monitor the implementation and updating of the EHB.
  • Allow states to adopt state-specific EHB definitions, but only if they meet the same criteria established for EHBs generally, and only upon Department of Health and Human Services (HHS) review and approval.
  • Establish a mechanism for the annual update of the EHB package, with the goal that it becomes more fully evidence-based, specific, and value-promoting over time.
  • Establish an independent National Benefits Advisory Council, composed of diverse stakeholders, to make recommendations regarding updates to the EHB.

HHS, which sponsored the IOM report, is responsible for determining the specific services to be covered in the initial EHB package, as well as future updates. It will use the report’s recommendations in developing the final EHB package, which is expected in 2012.

The IOM provides independent, objective advice to policymakers, health professionals, and the public. It was established in 1970 under the charter of the National Academy of Sciences, which also includes the National Academy of Engineering and the National Research Council.

For more on the report, go to www.iom.edu/ehb.


Amy Monahan

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