BHCG Monitor: Focus on Health Care Benefits
 
 

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What is the Promise of Comparative Effectiveness Research?

“In order for consumers to regain control, we must be as smart as the marketers selling to us. Consumers need the ability to accurately compare.” So were the words of John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, during a presentation on the merits of Comparative Effectiveness Research (CER) sponsored by the Business Health Care Group back in 2009. As relevant today as ever, Dr. Santa’s words make the case for CER.

According to the independent Congressional Budget Office (CBO), CER has the potential to lower health care costs over the long term and improve the quality of care. In fact, CER’s promise for increasing health care value is why funding for CER was included as an important feature of the Affordable Care Act (ACA).

The ACA created a new independent nonprofit, the Patient-Centered Outcomes Research Institute, or PCORI, to fund and disseminate CER results. The ACA requires employers with self-insured plans to pay a $2 per covered life per year PCORI fee and insurance carriers must pay these fees for insured plans to help fund PCORI and CER.

A definition of CER and Patient-Centered Outcomes Research

In today’s health care system, consumers, payers and providers must often evaluate the merits of multiple treatment options without the benefit of knowing what works better or if more expensive treatment is delivering value. Research that compares “different interventions and strategies to prevent, diagnose, treat and monitor health conditions” (National Institutes of Health) is known as Comparative Effectiveness Research. It is designed to provide evidence on the effectiveness, benefits and harms of different treatment options.

Taking CER one step further, Patient-Centered Outcomes Research (PCOR) “helps people and their caregivers communicate and make informed healthcare decisions, allowing their voices to be heard in assessing the value of healthcare options” (PCORI). An important distinction of PCOR is that it is inclusive of a particular patient’s preferences and needs and focuses on outcomes that are most important to an individual (e.g., survival, function, symptoms, quality of life).

How is CER conducted?

CER follows a set of principles that form a systematic process of review. Typically, the questions that are most important for patients and providers to have answered are carefully chosen and current research on these questions is examined. Usually studies that measure health outcomes and those that measure benefits and harms over extended periods of time are the most relevant. These studies, such as randomized controlled drug trials or observational studies are then defined, collected and assessed.

CER is intended to provide results that are applicable to “average patients.” CER examines research data thoroughly to ensure that patients and providers can assess the quality and relevance of the available data and also point out areas of clinical uncertainty. The pros and cons of different treatment and tests are then presented in a consistent way so that decision makers can assess the tradeoffs involved for different treatments and strategies. CER also highlight areas where evidence indicates that benefits, harms and tradeoffs are different for specific patient groups.

PCORI’s priorities

PCORI focuses on CER and will pursue its mission to “help people make informed healthcare decisions and improve healthcare delivery and outcomes” by identifying priorities for research, creating and funding a research agenda, and providing patients and their caregivers with useful research information. In 2012 PCORI identified five areas where additional health research is needed to give patients and providers more information to support decision-making, regardless of the health condition or disease:

  1. Assessment of prevention, diagnosis, and treatment options to see which ones work best for different people with a particular health problem
  2. Improving health care systems (improving access, patient self-care, use of health information technology, coordinating care for complex conditions, deploying workforces effectively)
  3. Communication and dissemination research
  4. Addressing disparities across patient populations and identifying the care required to achieve best outcomes
  5. Accelerating PCOR and methodological research (building infrastructure, improving analytic methods and training all stakeholders to participate in the research)

To be sure, PCORI’s mission will require significant funding and resources to make the desired improvement to the health care system. Thus far (four years into it), PCORI has dedicated less than 40 percent of its research funding to CER (#1 in the listed priorities above). PCORI has approved 279 awards totaling more than $464.4 million to fund patient-centered comparative clinical effectiveness research projects to date. However, PCORI’s total estimated budget is set to more than double from $320 million in fiscal year 2013 to at least $650 million annually for fiscal years 2014 through 2019, increasing CER funding to at least 70 percent of PCORI’s research funding.

Employers, private insurers and enrollees contributing to PCORI’s budget expect actionable results in exchange for their investment. PCOR is intended to help patients and providers communicate and make informed decisions. It will indeed be worth the investment if it can answer important questions like “Given my needs, what can I expect will happen to me?; “What are the pros and cons of my options?”; “What can I do to improve the outcomes that are important to me?”; and “How can health care providers and facilities work with me to make the best decisions about my health and health care?”

Works Cited

(n.d.). Retrieved March 2014, from Patient-Centered Outcomes Research Institue: http://www.pcori.org/

Comparative Effectiveness Research (CER). (n.d.). Retrieved March 2014, from U.S. National Library of Medicine: https://www.nlm.nih.gov/hsrinfo/cer.html

Comparing the Effectiveness of Health Care. (2014, January 24). Retrieved March 2014, from Center for American Progress: http://www.americanprogress.org/issues/healthcare/report/2014/01/24/82775/comparing-the-effectiveness-of-health-care/

Effective Health Care Program. (n.d.). Retrieved March 2014, from U.S. Department of Health & Human Services: http://effectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-effectiveness-research1/how-are-comparative-effectiveness-reviews-conducted/

 

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BHCG Monitor: Focus on Health Care Benefits - April 2012