Biotechnology Healthcare - July/August 2008 - (Page 28)

“It is political death” to mandate simultaneous evaluation of clinicaland cost-effectiveness in any CER proposal, says Gail Wilensky, PhD. Fueling the consensus is the growing realization that payers— both public and private—are about to reach the breaking point on healthcare costs and, upon closer examination, are not happy with what they have been paying for. “We cannot indefinitely sustain the spending growth rate that we’re on now, and we have pretty clear evidence that we are not getting good quality or good patient safety from that spending,” says Gail Wilensky, PhD, senior fellow at Project HOPE in Millwood, Va., and a leading policy analyst advocating for comparative effectiveness research (CER). Last January, the Institute of Medicine called on Congress to establish a program that can become “a trusted resource for reliable information” on the effectiveness of health services. In making its announcement, IOM noted that: • Spending on ineffective care contributes to rising health costs and insurance premiums. • Variations in treatment reflect disagreement about best practices. • Patients and insurers cannot be confident that providers deliver the most effective care. THE PLAYERS Although its call to action may be the most influential, the IOM proposal is only one of many to emerge in the past year. Others, too, have weighed in with support — though rather lukewarm in some cases — for CER. Purchasers. Pointing out that as much as 33 percent of healthcare dollars are wasted on unnecessary or ineffective care, the National Business Group on Health emerged as an early advocate for CER. The Business Group, representing about 300 large employers who provide coverage for 55 million Americans, proposes that 1 percent of total healthcare expenditures be devoted to comparative effectiveness analysis, technology assessment, health services research, and dissemination of findings. Payers. America’s Health Insurance Plans (AHIP), which represents nearly 1,300 insurers that cover more than 200 million lives, and the Blue Cross and Blue Shield Association, comprising 39 independent Blues plans that, together, provide coverage for 99 million Americans, each introduced proposals to create a new CER infrastructure and research program. Further, both companies have offered to help pay for it. Government. The Medicare Payment Advisory Commission and the Congressional Budget Office both advocate for CER. CBO Director Peter Orzsag told Congress that healthcare costs “constitute the nation’s central fiscal challenge” and identified CER as one of very few possible interventions (CBO 2007). In its report, CBO said CER, combined with incentives to encourage its findings, “could eventually … yield lower healthcare spending without having adverse effects on health. Over the long term, the potential reduction in spending below projected levels could be substantial.” Industry. In late 2007, the Biotechnology Industry Organization, Pharmaceutical Research and Manufacturers of America, and AdvaMed, an association representing manufacturers of medical devices and diagnostic tools, each issued separate statements in support of CER. Their support was tempered, though, by caveats about how the research should be conducted and how findings should be used. Patients and physicians. In December 2007, nearly 90 groups — primarily such advocacy organizations as the Alzheimer’s Association and Easter Seals — signed a letter about CER to members of Congress. Although the letter did not explicitly oppose CER, the signatories asked to have their concerns about the implications of CER considered as comparative effectiveness advances. THE POTENTIAL What a CER initiative would look like remains to be seen. Proposals so far include a publicprivate partnership similar to the National Quality Forum, a quasigovernmental organization like IOM, expansion of an existing agency, such as the Agency for Health Care Quality or National Institutes of Health, or the creation of a new federal agency. At the request of the New Yorkbased Commonwealth Fund, the Lewin Group, a healthcare and human service consulting company in Falls Church, Va., estimated that one model—a public-private partnership initially funded at $800 million a year and rising from there— could wring $367 billion in savings from the healthcare system over a 28 BIOTECHNOLOGY HEALTHCARE · JULY/AUGUST 2008

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - July/August 2008

Biotechnology Healthcare - July/August 2008 Openers Contents Editorial/David B. Nash, MD, MBA Drug Track Health Plan Confidential Rheumatoid Arthritis A Decade of Trial, Error, False Starts, and Hope What Path Will Comparative Effectiveness Research Take? RA Therapies in Development: A New Generation of Relief Assessing the Full Impact of RA on Employers and Payers Stem Cells: Health Insurance You Can Bank On Specialty Pharmacy Employer to Employer Personalized Medicine Trends Clinical Briefs

Biotechnology Healthcare - July/August 2008

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