Managed Care - August 2012 - (Page 30)

in my role now for over 20 years, and one of my responsibilities during that time has been leadership development within our medical group. I just spent the morning with 160 primary care physicians in a professional development program on leadership. It’s an ongoing responsibility of leadership to identify emerging leaders and to help them translate their skills as a clinicians into identifying and solving system problems. MC: I like the way you put that. Will you tell us about your role on the board of the Patient-Centered Outcomes Research Institute? LEviNE: The creation of PCORI in the Affordable Care Act came about because of an understanding on the part of members of Congress that transforming the way care is delivered has a lot to do with actually understanding what interventions make a difference in health care. So the goal was to make a substantial investment in a new private, independent, not-for-profit entity that would be partly funded by Medicare and partly funded by health plans and employers to accelerate the production of patient-centered outcomes research. MC: How will it be different from other agencies funding research? LEviNE: This is not going to be investigator-driven research. The research topics and the process of applying for and receiving grants from PCORI will require meaningful engagement of patients, from formulation of the research questions through publication of the results and dissemination of the findings. So patient-centeredness and the questions that patients care about and want answered — and the questions that physicians need answered to support their patients — will be the nexus of what gets researched and what gets funded by PCORI. Another thing that is extremely exciting about this is that a substantial part of our investment is going to be in studies of the dissemination and implementation of research: What does it take to get meaningful scientific findings from the page of the journal into every doctor’s practice? MC: I have read that it takes 17 years for a sound new development to get widely disseminated. LEviNE: We know that the golden path to care improvement does not lie just in publication in a peer-reviewed journal. PCORI will be investing in dissemination research. Every PCORI project will have to have an implementation plan that demonstrates who the beneficiaries will be and how information will get to them and to the doctors who care for them. We are ramping up our understanding of what roles specialty societies, patients, and advocacy groups can play in disseminating meaningful evidence. We would like every physician in the country to have rapid access to information in a way that is actionable and comprehensible. It’s an aspirational goal, but it’s one that we are all very excited about. MC: You sit on the Committee on Evidence-Based Benefit Design of the National Business Group on Health. What are you able to contribute to that discussion? LEviNE: We haven’t relied on benefit design to drive evidence-based practice because we have clinical experts organizing that work. Evidence-based benefit design is largely used in the self-insured market. Part of what I bring is an understanding of what evidence there is and how it can be used to identify where interventions are warranted. Benefit design is a blunt instrument, and there are very few things in health care where you can say “always” or “never.” For example, evidence for the use of spine surgery in back pain is pretty slim, but that doesn’t mean that surgery is never indicated in someone with back pain. Part of the work of the committee is to help employers understand the nuances of that and who should determine appropriateness of care. In our system, those decisions are largely left up to the medical group. Those are not the actions of the insurer. MC: Do you view employers as the engine of change in a lot of this? LEviNE: They are very effective advocates on the part of their employees. They understand fully that their investments in health care and health insurance represent foregone wages, and they are committed to having their employees get the best possible value out of those investments. I have to give them credit; these are people whose business isn’t health care. Under Helen Darling’s very able leadership, the members of the NBGH spend a lot of time and energy trying to ensure that they are not just getting a fair deal financially, but that their employees are benefiting in terms of health and productivity from investments that are made. MC: Thank you. 30 MANAGED CARE / AUGUST 2012

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Contents
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine
Outlook

Managed Care - August 2012