Looking at CER from the managed care organization perspective.

Area of Science:

• Health Services Research
• Health Policy Analysis
• Comparative Effectiveness Research

Background:

• The volume of comparative effectiveness research (CER) is growing, providing managed care organizations (MCOs) with more data for decision-making.
• MCOs may lack preparedness to integrate this expanding CER data into existing practices and policies.

Purpose of the Study:

• To outline the future impact of health care reform on MCO populations.
• To review past instances of MCOs utilizing CER data.
• To identify critical questions for MCOs regarding CER integration into future decision-making.

Main Methods:

• Literature review of CER utilization by MCOs.
• Analysis of health care reform's projected effects on MCOs.
• Identification of MCO decision-making processes influenced by CER.

Main Results:

• Health care reform will expand insurance coverage, increasing market complexity and the availability of CER.
• Past MCO use of CER for policy decisions has been suboptimal, though successful integration examples exist (e.g., Intermountain Healthcare).
• Future MCO success requires assessing internal capabilities (expertise, technology, processes) and understanding CER relevance to benefit design and customer needs.

Conclusions:

• Health care reform and increased CER necessitate MCO investment in infrastructure and market understanding.
• MCOs must develop strategies to effectively leverage CER amidst a transforming healthcare landscape.
• Adapting to evolving customer needs and market dynamics is crucial for MCOs integrating CER.