Managed Healthcare Executive - April 2009 - (Page 15) {EXECU TIV E PROF ILE} Gail R. Wilensky, PhD, is a healthcare economist and an elected member of the Institute of Medicine, including two terms on its Governing Council. She is the president of the Defense Health Board, vice chair of the Maryland Health Care Commission and a trustee of several other organizations. Also an advisor for the Commonwealth Fund and Robert Wood Johnson Foundation, Wilensky testi es frequently before Congress. From 1992 to 1993, she served as Deputy Assistant to President George H. W. Bush, and prior to that, was the administrator of the Health Care Financing Administration. Her broad background in healthcare also includes chairing the Medicare Payment Advisory Commission and two task forces for veterans and military retiree healthcare. Currently, she is a senior fellow with Project HOPE. Wilensky earned a bachelor’s degree in psychology and a PhD in economics from the University of Michigan. parative E ectiveness Information,” touched o major discussion, and many consider her the mother of the debate. In it she says, “The function of a comparative e ectiveness center in the United States would be to provide credible, objective information on the comparative e ectiveness of alternative therapies and technologies, not to make centralized coverage decisions.” Wilensky and others have advocated that CER should be conducted by a separate entity that is “close, but not too close to government.” Policies in the stimulus bill have now placed CER in the hands of federal agencies, which many players disagree with. What most have agreed upon, however, are the attributes that must be embodied by the country’s CER initiative: objectivity, credibility, transparency and independence from political pressure. “There’s a good rationale for creating a new independent agency in government, but it’s not critical,” Wilensky says. “It’s really a question of what the data is used for and whether the circumstances are such that the data, the analyses and the results that are produced have good credibility. That will only happen if the research priorities are done in an open and transparent way and if the results of the studies, reviews of existing studies, and new prospective trials that are undertaken are done in a way that looks objective and credible and not politically driven.” Delegating the CER task to government agencies was the obvious choice, she says, but that might not o er the most political protection. History has proven that such protection is a necessary attribute for the program. In the mid-1990s, the Agency for Health Care Policy and Research, which was charged with researching both the clinical and cost e ectiveness of treatments, reported that back surgery had low e cacy, drawing the ire of many providers and device makers that pro ted from the surgeries. Soon after, House and Senate bills proposed to cut the agency’s funding to the point of essentially shutting it down. Eventually, the agency was restructured and became AHRQ, taking on a focus toward clinical improvement and evidence-based practice of medicine—not cost evaluation in particular. The council of government agencies now responsible for CER has no authority to restrict payments, make coverage decisions or establish national practice guidelines, and a Congressional report speci cally noted that detail. Likewise, according to AMA’s Dr. Rohack, the new policy “does not grant Medicare o cials new authority to impose a coste ectiveness standard.” Cost Not Ignored Wilensky says the industry must take cost into account if there is any hope of leveling out the steep spending curve. “[It’s] not that cost e ectiveness shouldn’t be used by payers in making reimbursement decisions, but I think that is a separate issue and ought to be regarded as separate from the generation of comparative clinical-e ectiveness information,” she says. “That’s what needs to APRIL 2009 15
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