Managed Care - September 2008 - (Page 15)

tions, transportation, energy, and finance, but it has not been used to a great degree in health care because it has always been difficult to model biology, Eddy says. “We’ve now shown that it’s possible,” he says. “We may be breaking ground in medicine, but we’re not breaking ground in modeling. Models will play a larger and larger role in medicine.” Eddy spoke recently with MANAGED CARE Editor John Marcille. MANAGED CARE: You’ve been concerned about the use of evidence in medicine for a long time. Where do you think we are today? EDDY: We’re not yet where we ultimately want to be, but we have made a lot of progress. When I started working on this back in the ’70s, the concept of requiring evidence as the basis for things like guidelines wasn’t even on the board. Guidelines were set by experts sitting in a room, thinking hard, reaching consensus, and then going out for lunch. That’s entirely different now. Everyone is talking the talk. Everyone is saying that their guidelines are evidence-based. The extent to which they actually are evidence-based varies from organization to organization and guideline to guideline, but at least the concept is fully accepted. The application of evidence-based principles is still followed to different degrees by different organizations, but that doesn’t discourage me too much. It takes time, and we still have gaps in evidence, which makes it difficult. But everyone is moving in the right direction. MC: How do you explain Archimedes to someone who may not have heard about it? EDDY: First of all, Archimedes is a health care modeling company. We have built a full-scale simulation model that includes the underlying anatomy and physiology, signs and symptoms of diseases, patient behaviors, and all the logistics and utilization of health care services, such as visits, admissions, and financial costs. The purpose is to enable us to analyze problems and provide information about the consequences of different decisions that clinicians and administrators might make so that they can be better informed about possible outcomes and thereby make better decisions. MC: What activities are at the center of what’s happening with Archimedes today? EDDY: We have three main types of users: health plans, including Kaiser Permanente; governmental and other types of agencies, such as the Centers for Disease Control and the National Committee for Quality Assurance; and pharmaceutical companies. Right now the model is used in what might be described as a consulting mode. Organizations describe a problem or a question to us and we use the model to analyze it. Then we work with them to understand the consequences of the answers and to define additional analyses that might be done. The model is very large and complex, and it takes a lot of expertise to run it. However, in the future, maybe two or three years from now, organizations will be able to use the model on their own on a day-to-day basis. We have a $15.6 million grant from the Robert Wood Johnson Foundation to create an interface to the model that can be used directly over the Web. MC: That’s the ARCHeS Project? EDDY: Yes. That stands for Archimedes Health Care Simulator. MC: And when it is implemented, will people have the full power of Archimedes at their disposal or will it be a subset of data? EDDY: We do two main types of applications: population-based applications and individual-based applications. Population-based applications address interventions such as creating new care guidelines, changing treatment goals, or implementing pay-for-performance programs. Organizations will be able to use ARCHeS to address those kinds of population-wide interventions. The other type of analysis is specific to particular patients. We take all the clinical information about a patient, analyze it, and provide information to the physician and to the patient about that particular patient. That application is not part of ARCHeS. We can make that available to organizations through their clinical information systems, but that application of the model is different from ARCHeS. MC: Will there be a time when the physician’s electronic medical record talks directly to Archimedes to get advice? EDDY: We have a project like that with Kaiser Permanente that begins this fall. Patient information will come in through the medical record and go to Archimedes. Archimedes will analyze the record, estimate the changes of various outcomes SEPTEMBER 2008 / MANAGED CARE 15

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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