Managed Healthcare Executive - April 2009 - (Page 14) {EX EC U T I V E PROFIL E} system should become more thrifty. It sounds easy enough: If direct constraint on demand—rationing, as many other countries have done—is unacceptable to the American people, then smarter spending should be the strategy. Buy what works. Health plans, employers and politicians have long had their hopes riding on a smart-spending strategy, in spite of the fact that there is little information available to tell them what treatments actually are the smart choice. At last, there’s now a bit of light at the end of that tunnel. A provision in the American Recovery and Reinvestment Act (the stimulus bill) provides $1.1 billion to accelerate comparative-e ectiveness research (CER). CER is the comparative study of alternative ways to treat medical conditions—not just the discrete study of treatments on their own merits—in an e ort to discover which ones are most e ective. It is also meant to create a growing base of evidence, which would help patients and doctors decide on the best course of care among several treatment options. And, many hope it will lead to smart spending. In theory, the government-funded CER would help de ne the best medical treatments, while the private market would take it a step further to de ne the best buys. spokesperson for AHRQ tells MHE that it will also seek external input as it has done in the past. IOM’s nal report is due in June. “There’s no doubt that comparative e ectiveness research is needed to help physicians gain knowledge about whether new treatments outperform existing treatments,” says J. James Rohack, MD, president-elect of the American Medical Assn. “The measures included in the economic stimulus bill are an important step toward getting that information into the hands of physicians.” There is little CER data available now. Previous government funding provided AHRQ just $50 million for CER in scal year 2009. Also, drug and device companies haven’t been compelled to do CER, because there is no guarantee that their products would come out ahead of other treatments. “We don’t have in this country the kind of comparative analysis that is needed to empower physicians and their patients to make the most informed healthcare decisions,” says Robert Zirkelbach, spokesperson for America’s Health Insurance Plans (AHIP). “For example, the FDA might approve a drug, and there might be evidence to show that it works for a particular condition. But what we don’t know is how well it works compared to other drugs, treatments and therapies.” Zirkelbach says the nation must prioritize that kind of research for the sake of quality. He and Wilensky both cite the pronounced variation in care nationwide as reason enough to accelerate CER and put it into practice. Agency Council According to policy, the new Coordinating Council for Comparative Effectiveness Research, which is made up of 15 representatives of federal agencies, including nine physicians, will coordinate the research and advise the president. Steps include identi cation of priorities from the Institute of Medicine (IOM), followed by work among the Department of Health & Human Services (HHS), the Agency for Healthcare Research & Quality (AHRQ), the National Institutes of Health (NIH), and the council. A 14 APRIL 2009 “And it’s important for consumers and employers to know what they’re getting for their money in the healthcare system,” Zirkelbach says. Prescription for CER Wilensky’s comprehensive article in the Nov. 7, 2006, issue of Health Affairs, “Developing A Center For Com-
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