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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Looking at CER from the managed care organization perspective.

H Eric Cannon1

  • 1SelectHealth, Salt Lake City, UT 84120, USA. Eric.Cannon@selecthealth.org

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|May 15, 2012
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Summary

Managed care organizations (MCOs) face increasing comparative effectiveness research (CER) data due to health care reform. MCOs must adapt by investing in infrastructure and understanding market changes to effectively use CER for decision-making.

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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.