Managed Care - May 2008 - (Page 13) LEGISLATION & REGULATION be produced by assessing each payer a small fraction of its revenue — .05 percent of the money spent by the public health agencies and .05 percent of private premiums. “It needs to be a public/private partnership,” says Guterman, “to get a buy-in from all the interested parties.” In managed care’s interest Helping pay for this kind of work is exactly what managed care should encourage, says Alissa Fox, vice president for legislative and regulatory policy at the Blue Cross and Blue Shield Association. “This is so important that we recommend all payers be assessed. It shouldn’t be just government run. Everyone should have a seat at the table. If it’s 100 percent government it would be more political; we want to make sure the science prevails.” “It’s exactly the kind of initiative that can deliver significant savings as well as improve care by offering unbiased information on medical alternatives,” says Steven Wojcik, vice president for public policy for the National Business Group on Health. “It’s needed so we know that we’re getting the best value for our dollars.” It’s a logical approach to avoid the rationing of therapies that will inevitably follow a sustained failure to rein in costs. Wojcik has heard some patient groups expressing concern that comparative effectiveness would spur one-size-fits-all medicine, discouraging payers from covering therapies that apply to only a segment of the population. “Our view is the opposite. The research stops the one-size-fits-all research we have comparing therapies to a placebo and allows us to tailor it to specific needs. Instead of mass marketing medical interventions, this research will show which interventions would be most effective.” Ideally, the NBGH would like to see research cover both effectiveness and cost, but it will compromise at the beginning. “Just having that information on clinical efficacy is definitely progress,” says Wojcik. It’s hard to find anyone completely op- posed to the legislation. However, the companies that are most likely to find their products under the microscope have some clear reservations about how Congress should define a new institute’s mission. “Proposals to expand governmentsupported comparative clinical effectiveness research should be structured to promote better patient health and timely patient access to needed therapies, rather than denying or delaying patients’ access to beneficial care, as often occurs in Europe and Australia,” said Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, before the Senate draft was circulated. “Comparative effectiveness studies could be very valuable,” agrees AdvaMed’s Nexon, “but the real issue is how this stuff is used” as well as the nature of the studies that will be mounted. In particular, he adds, comparative research on cost effectiveness should not be included. “We’ve never accepted that people should get second-rate care based on cost,” says Nexon. As for the ambitious cost savings outlined by advocates, “We should not regard comparative effectiveness research as a solution to the cost problem. Nothing says that it will make that much difference in the behemoth of the system we have.” It might not really address the problem of cost, says David Nexon, of AdvaMed. Waiting for the launch At least a few of the advocates appear willing to give up cost comparisons now, if they can get a green light to start efficacy research. “We think cost effectiveness is important,” says Fox, “but we think it’s so important to get this institute off the ground, it should first focus on clinical effectiveness.” It couldn’t be approved too fast for the Blues. “We would love to see something happen this year,” Fox adds. “Savings won’t be automatic; it will take a while. We need to get the best information into the hands of consumers and physicians, and the quicker you get it going, the quicker you improve the health care system.” MC MAY 2008 / MANAGED CARE 13
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.