AS.280.100 Lecture Notes - Lecture 9: Multistakeholder Governance Model
16 Sep 2016
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4/2/2012 8:49:00 PM
% of increasing health care costs are related to medical technology= 25%
• Blue Cross Blue Shield estimates 18%
• others say anywhere 25-81%
Statuatory Basis for Coverage
• Reasonable and Necessary
o Working definition per CMS
o Adequate evidence to conclude that the item or service
▪ improves net health outcomes
That matter to patients
▪ generalizable to the Medicare population
o Medicare says its not neccesary b/c “not proven”
% of clinical practices supported by high quality evidence:
• ~40%
o 50-60% on consensus of experts
CER Hypothesis
• Gaps in evidence will be reduced with greater engagement of
decision makers (patients, clinicians, payers) in:
o Deciding which questions to study
o Working with researchers on study design
find more resources at oneclass.com
find more resources at oneclass.com
CER in PPACA
• Creates Patient-centered Outcomes Research Institute (PCORI)
o Independent, private, non-profit
• Funding builds to ~$600 million by 2013
• Comparative clinical effectiveness
o Evidence generation – new studies
o Evidence synthesis – technology assessments
o Dissemination (20% of budget)
• Multi-stakeholder governing board
PCORI
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
% of increasing health care costs are related to medical technology= 25: blue cross blue shield estimates 18, others say anywhere 25-81% Statuatory basis for coverage: reasonable and necessary, working definition per cms, adequate evidence to conclude that the item or service improves net health outcomes. That matter to patients: generalizable to the medicare population, medicare says its not neccesary b/c not proven . % of clinical practices supported by high quality evidence: ~40, 50-60% on consensus of experts. Cer hypothesis: gaps in evidence will be reduced with greater engagement of decision makers (patients, clinicians, payers) in, deciding which questions to study, working with researchers on study design. The same test or treatment can be done with different technologies: old school vs. new. Health care must be: safe, effective: evidence based, timely: reduce waits and harmful delays, patient centered, efficient: avoid waste, equitable.
