Managed Care - March 2008 - (Page 30) Government works with HMO researchers he new Cardiovascular Research Network builds on the long-term success of the Cancer Research Network, a collaborative of health plan researchers now in its ninth year, and the Centers for Education and Research on Therapeutics (CERTs) and Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network, a national initiative to conduct research and provide education that increases the appropriate use of drugs, medical devices, and biological therapies. The CERTS initiative, led by Richard Platt, MD, at Harvard Pilgrim Health Care and funded primarily by the Agency for Healthcare Research and Quality (AHRQ), seeks to provide comparative information on the risks, benefits, and interactions of new and older therapies and to guide cost-effective use of treatment options. The HMO RN is one of 14 participating organizations; its peers include the University of Chicago and Duke University Medical Center. Meanwhile, the cancer network researchers, funded by the National Cancer Institute and AHRQ, are studying the accuracy of automated data on colorectal cancer screening, disparities in lung cancer outcomes, how women who have preventive mastectomies fare, and more. The Cancer Research Network’s unusual feature is its population laboratory of more than 11 million enrollees in health plans around the country. Because of their affiliations with HMOs, the researchers can pool pharmacy, lab, claims, enrollment, and other administrative data with patient survey data from patient portals and electronic medical record data. The CRN’s goal is to increase the effectiveness of cancer interventions — whether they prevent, cure, or support patients undergoing treatment. To date, more than 40 studies have been undertaken. “Epidemiologic, behavioral, health services, biophysical — it’s all of those things,” says Katherine Newton, PhD, associate director for external research at the Center for Health Studies at Group Health. The CRN members have overcome the common hurdle that comes from data stored in myriad ways, using variables that do not match from one data set to the next. The CRN virtual data warehouse — essentially a series of data standards and automated processes at each of the HMO research centers — allows software written at one site to pull data from all the other sites’ databases. This gives researchers rapid access to data with many fewer data-matching hassles than most collaborators experience. T The researchers benefit from access to information about health plan members (always subject to federal research regulations, of course) and the health plans benefit from rapid access to the research results. If health plan researchers discover, for example, a problem with a medical device or a better strategy to treat a condition, they notify health plan representatives who, in turn, pass the information on to their affiliated clinicians. This can happen very quickly. “This is as opposed to the normal way that research findings are disseminated — which is to publish and hope people read the article,” he says. One example: Researchers at Kaiser Permanente of northern California, studying COX-2 inhibitors, discovered a potential problem long before the risks of the drugs were well known. “We immediately got data to the executives, they made decisions, it went through pharmacy and therapeutics, and we stopped prescribing that medication,” Go says. Perhaps the most widely known research to emanate from the Group Health Center for Health Studies is the work underlying the Free & Clear smoking cessation program. The researchers determined that copayments deterred smokers from participating in smoking cessation programs. Group Health later eliminated the copayment. While the research organizations that are affiliated with health plans work primarily on individual projects, they come together to collaborate on HMO RN endeavors such as the CVRN. A lead organization — in this case, the Kaiser Permanente division of research in Oakland — receives the research grant, and other plans participate as subcontractors. “What is unique about this group is the goodwill between these institutions and their investigators,” Newton says. “These organizations collaborate in ways that make the research dollar go a lot further, and we can have access to national populations for research studies. It is really a national model for collaboration.” Cardiovascular research network The new research network is tackling the leading cause of death and disability in the United States — and one of the fastest-rising causes of death and disability worldwide. The initial funding will support 30 MANAGED CARE / MARCH 2008
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