Harald Schmidt: Research data in benefit design

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  • 1. Cost, Evidence and Comparative Effectiveness Research Data in Benefit Design – An Exploratory Study Harald SchmidtFellow,Fellow Kolleg Forschergruppe, Uni Münster Research Associate LSE Health Forschergruppe Münster, Associate, Nuffield Trust, H3 March 11
  • 2. Objectives• With CER push: (how) will public and private payers consider g value in benefit design?• Implementation mechanisms: what’s feasible and fair?• Within vs across disease prioritizations: potential?• What role for public engagement?• Patient Centered Outcomes Research Institute (PCORI): how can it help maximize CER benefits?
  • 3. Objectives• With CER push: (how) will public and private payers consider g value in benefit design?• Implementation mechanisms: what’s feasible and fair?• Within vs across disease prioritizations: potential?• What role for public engagement?• Patient Centered Outcomes Research Institute (PCORI): how can it help maximize CER benefits?
  • 4. Two examplesProstate cancer management, Plavix/Effient trial:Policy spectrum:• Provide all options – physician/patient judgment• Differential copays /Value Based Insurance Design ( p y g (VBID) )• Other steering (information, counseling…)• Deny coverage/access• Other-> Consensus: no ban, but shared decision making and use of info. info Over time move down the ladder (3 5 Y) time, (3-5
  • 5. Copays and VBID/’top-up’ paymentsPro:• “employers need it simple” branded/generic concept clear and y g accepted, signaling effectCon:• blunt & potentially unfair (Newhouse/RAND), (Newhouse/RAND)• operationalizability: “just good for low hanging fruit”?Key:• robustness of evidence, admin cost, feasibility (co-pays used or not… payers vs payer/provider systems)• Fairness within group (Plavix): don’t penalize victims of don t genetic lottery• Fairness across groups: Who and why? (diabetics….)• Instead of drugs: focus on choice of providers, wellness incentives
  • 6. Fellowship meetings and travel opptand VBID/’top up’ payments VBID/ top-upSept: Orientation & qualitative methods / NYCNov: CMWF Intl Symposium / DCJan: IHI/CMWF Fellow Summit / BostonFeb: Policy mtg / DC y gMay: Canada tripJune: final reporting seminar / NYCResearch related travel…