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Meaningful engagement of decision makers in priority-setting

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Meaningful engagement of decision makers in priority-setting

  1. 1. Engaging Decision Makers in Comparative Effectiveness Research Sean Tunis MD, MSc July 11, 2008
  2. 2. Calls for a National Institute of Comparative Effectiveness Research (NICER) <ul><li>MMA Section 1013 (2003) </li></ul><ul><li>Gail Wilenksy, Health Affairs (11/06) </li></ul><ul><li>Health Industry Forum (11/06) </li></ul><ul><li>AHIP, BCBSA proposals (early 2007) </li></ul><ul><li>MedPAC report, CBO testimony (6/07) </li></ul><ul><li>Obama, Clinton, Edwards reform plans (mid 2007) </li></ul><ul><li>CBO final report (12/07) </li></ul><ul><li>Commonwealth ‘Bending the Curve’ report (12/07) </li></ul><ul><li>House and Senate legislative proposals </li></ul>
  3. 3. Medicare Spending per Capita in the United States, 2003 Source: Dartmouth Atlas of Health Care. $7,000 to 11,352 (63) 6,500 to < 7,000 (53) 6,000 to < 6,500 (56) 5,500 to < 6,000 (64) 4,272 to < 5,500 (70) Not Populated Source: www.dartmouthatlas.org.
  4. 4. CER Definition <ul><li>“Research evaluating and comparing the implications and outcomes of 2 or more health care strategies to address a particular medical condition” </li></ul><ul><li>Primary focus on drugs, devices, procedures, diagnostics </li></ul>
  5. 5. Methods <ul><li>Systematic reviews / HTA </li></ul><ul><li>Retrospective studies </li></ul><ul><ul><li>with claims and/or EMR data </li></ul></ul><ul><li>Modeling (+/- cost data) </li></ul><ul><li>Prospective observational or experimental studies </li></ul>
  6. 6. How is CER Different <ul><li>More political insulation </li></ul><ul><li>Oversight by multi-stakeholder board </li></ul><ul><li>Increased transparency </li></ul><ul><li>Improved observational methods </li></ul><ul><li>Adoption of electronic health records </li></ul><ul><li>Much more money </li></ul><ul><li>Greater determination (and panic) </li></ul>
  7. 7. Built By and For Decision Makers <ul><li>Evidence enterprise designed around the needs and use of decision makers </li></ul><ul><ul><li>Patients, clinicians, payers, policymakers </li></ul></ul><ul><li>They must be meaningfully engaged in all aspects (priority setting, study design, etc) </li></ul><ul><li>Limited success with meaningfully engaging decision makers </li></ul><ul><ul><li>some notable exceptions: CUE, NBCC, JDRF </li></ul></ul><ul><ul><li>limited effort to broadly, systematically improve </li></ul></ul>
  8. 8. Center for Medical Technology Policy <ul><li>Structure : private, non-profit </li></ul><ul><ul><li>First 2 years: foundations, government </li></ul></ul><ul><ul><li>2008+: diverse membership </li></ul></ul><ul><li>Primary Mission : to support collaborative efforts that will improve the quality and efficiency of prospective studies of new and existing medical technologies </li></ul><ul><li>Focus: Evidence development guided by decision makers (DBEM) </li></ul><ul><ul><li>Patients, clinicians, payers, policy makers </li></ul></ul>
  9. 9. CMTP Project Categories Applied POLICY and METHODS Projects PRIORITIES for Evidence Development Trial DESIGN and IMPLEMENTATION Effectiveness GUIDANCE Documents I MPROVE THE Q UALITY AND E FFICIENCY OF R ESEARCH FOR D ECISION M AKING
  10. 10. Coronary CTA Protocol Development Workgroup Members and Observers <ul><li>Aetna </li></ul><ul><li>Kaiser Permanente </li></ul><ul><li>UnitedHealth </li></ul><ul><li>MN Medicaid </li></ul><ul><li>BCBSA </li></ul><ul><li>GE Healthcare </li></ul><ul><li>Siemens Medical </li></ul><ul><li>Philips Medical </li></ul><ul><li>Toshiba </li></ul><ul><li>AHA </li></ul><ul><li>Patient reps </li></ul><ul><li>ACC, ACRIN </li></ul><ul><li>FDA, </li></ul><ul><li>CMS </li></ul><ul><li>AHRQ </li></ul><ul><li>Clinical researchers </li></ul><ul><li>Health economist </li></ul>
  11. 11. Coverage for Evidence Development Workgroup Members <ul><li>General Electric </li></ul><ul><li>Blue Shield of California </li></ul><ul><li>Wellpoint/Anthem </li></ul><ul><li>Aircraft Gear </li></ul><ul><li>Fidelity </li></ul><ul><li>Kaiser Permanente </li></ul><ul><li>Washington State Office of TA </li></ul><ul><li>SEIU </li></ul><ul><li>University of Michigan </li></ul><ul><li>MD Anderson </li></ul><ul><li>Oklahoma Medical Authority </li></ul><ul><li>PacFed Benefits Administrators </li></ul><ul><li>Patient Advocates in Research </li></ul><ul><li>Center for Medical Consumers </li></ul><ul><li>Harvard University </li></ul><ul><li>Aetna </li></ul><ul><li>United Healthcare </li></ul><ul><li>California Association of Physician Groups </li></ul><ul><li>National Business Group on Health </li></ul><ul><li>California Pacific Medical Ctr </li></ul>
  12. 12. Engaging Patients - 1 <ul><li>There is a natural patient advocacy group for every topic. (Tele-ICU workgroup) </li></ul><ul><li>If there is group, members have to care about research. </li></ul><ul><ul><li>For some patient groups, it’s all about access, all the time. </li></ul></ul><ul><li>Technical nature of work requires belief that the results will matter </li></ul>
  13. 13. Engaging Patients - 2 <ul><li>Need subject-specific patient advocates as well as more general advocates – each brings a different perspective to the table </li></ul><ul><li>One of the most important characteristics of an effective and engaged advocate is “strong intellectual curiosity” </li></ul><ul><li>Smart people get energized by other smart people – bringing a variety of perspectives to the table makes the “stew” a lot spicier </li></ul>
  14. 14. Clinician Advisors Meeting <ul><li>Multi-stakeholder clinician group convened to discuss how to engage clinicians in CER </li></ul><ul><li>practicing MDs (community and academic), medical group medical directors, nurses, hospital system CMO </li></ul><ul><li>Broad agreement on willingness to help </li></ul><ul><li>Time pressure, money, and unfamiliarity with research were key constraints </li></ul>
  15. 15. Key Take Home Messages <ul><li>Decision makers will engage in evidence review and development if </li></ul><ul><ul><li>they believe their perspective is valued </li></ul></ul><ul><ul><li>they believe that the activity will have some impact </li></ul></ul><ul><ul><li>Carefully selected for being smart, energetic </li></ul></ul><ul><li>We (academics, researchers, etc) need to be more systematic learning to do this well </li></ul><ul><li>If we don’t meaningfully engage the decision makers, the enterprise will always struggle </li></ul>
  16. 16. Contact Info <ul><li>[email_address] </li></ul><ul><li>www.cmptnet.org </li></ul><ul><li>410-963-8876 </li></ul>

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