Comparative effectiveness research is intended to replace opinion and tradition, with hard science
Supplier success in a post‐reform healthcare market depends on many factors, including a fundamental and thorough understanding of the foundation of healthcare reform. This is part of an ongoing series designed to help Repertoire readers understand the implications of reform.
What’s good medicine, and what’s not so good? To what degree is medicine an art – and to what degree is it a science? Comparative effectiveness research may be a way to find out.
In 2009, The American Recovery and Reinvestment Act, or ARRA, authorized the expenditure of $1.1 billion to conduct research comparing “clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.” The funds were divided among the following organizations:
- $300 million for the Agency for Healthcare Research and Quality
- $400 million for the National Institutes of Health
- $400 million for the Office of the Secretary of Health and Human Services.
These groups were tasked with conducting research assessing the comparative effectiveness of healthcare treatments and strategies. Their efforts were broken into two categories:
- Conducting, supporting, or synthesizing new research.
- Encouraging the development and use of clinical registries, data networks, and other forms of electronic health data that can be used to generate or obtain outcomes-related data.
The ARRA was a starting point for comparative effectiveness research. A year later, the Affordable Care Act established the Patient-Centered Outcomes Research Institute, or PCORI. Its mission is to help people make informed healthcare decisions, and improve healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers and the broader healthcare community. The intended result is that patients and the public will make well-informed decisions that reflect their desired health outcomes.
Improve quality, reduce costs
The Affordable Care Act was designed to improve the quality of care while reducing the overall costs associated with that care. Comparative effectiveness research works on both.
Knowing the best course of action or treatment for a medical condition obviously benefits the patient, and proving an expensive treatment is less effective or ineffective may help insurers save money, reducing overall healthcare costs. But in some cases, comparative effectiveness also has the potential to increase healthcare costs.
Say, for example, there are two treatments currently in use. Treatment A costs $1,000 and has a 90 percent cure rate, while Treatment B costs $10,000 and has a 95 percent cure rate. Comparative effectiveness may determine that treatment B is the better option, even though it will significantly increase overall costs. This example begs the question: At what point must there be a trade-off between cost and benefit?
What do providers think?
Although many healthcare groups, including the American College of Physicians, have called for cost-effectiveness analysis, others view comparative effectiveness research as an intrusion by the federal government, and they believe that it will lead to cost-cutting decisions and the withdrawal of beneficial treatments.
Some surveys show that although many physicians may believe that comparative effectiveness research can improve the quality of care, they also fear it will limit their clinical freedom.
In summary, comparative effectiveness research compares new and existing data to determine how effective or ineffective various medical treatments are in improving patient outcomes. It aligns with the goals of the Affordable Care Act by improving care quality through choosing the best possible procedure or treatment for a patient, while reducing the overall cost associated with care by eliminating expensive testing and procedures where necessary.
MDSI – the parent company of Repertoire – has developed the Healthcare Reform Navigation Series, an online program designed to make the task of preparing your organization for 2014 and beyond easier. This series will help you and your team with online courses that explain many of the key elements integral to understanding reform and the transformation from fee‐for‐service to fee‐for‐value. The program includes a 12-month schedule of topics and live sessions with industry experts.
To learn more about the Healthcare Reform Navigation Series, contact Scott Adams, corporate vice president, at (800) 536-5312 or sadams@mdsi.org.