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Comparative effectiveness research: from clinical information to economic incentives
1Kaiser Permanente of Health Economics, School of Public Health, University of California, Berkeley, USA. james.robinson@berkeley.edu
Health Affairs (Project Hope)
|October 6, 2010
Summary
Comparative effectiveness research can control healthcare costs. This study explores how insurers can use coverage, cost-sharing, and payment policies to integrate this research into practice.
Area of Science:
- Health Services Research
- Health Economics
- Evidence-Based Medicine
Background:
- Comparative effectiveness research (CER) is proposed to reduce healthcare expenditures.
- Mechanisms for translating CER findings into practice, patient choices, and industry investment require further examination.
- Insurers utilize various financial and contractual strategies to manage healthcare resource allocation.
Purpose of the Study:
- To analyze how existing insurance mechanisms can be modified to incorporate findings from comparative effectiveness research.
- To identify pathways for integrating new evidence into healthcare decision-making and resource management.
Main Methods:
- Review of current insurance policies and practices.
- Analysis of potential adaptations for integrating comparative effectiveness research evidence.
- Examination of conditional coverage, consumer cost-sharing, provider contracting, and drug payment policies.
Main Results:
- Conditional coverage can be tailored to incentivize the use of more effective treatments.
- Consumer cost-sharing strategies can be adjusted to reflect evidence on treatment value.
- Provider contracting and drug payment policies offer opportunities to align financial incentives with CER findings.
Conclusions:
- Insurance mechanisms provide a viable framework for leveraging comparative effectiveness research.
- Adapting these mechanisms can guide physician practice, shape patient preferences, and influence manufacturer investment.
- Strategic integration of CER into insurance policies is crucial for cost control and improved healthcare value.
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