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A Roadmap for Improving Medicare's Application of Coverage With Evidence Development
Darius Lakdawalla1, Sean Tunis2, Peter Neumann3
1USC Schaeffer Center, University of Southern California, Los Angeles, CA, USA.
Summary
The Centers for Medicare and Medicaid Services' coverage with evidence development (CED) policy aims to improve access to new services and gather data. However, implementation issues hinder its effectiveness, requiring a roadmap for improvement.
Area of Science:
- Health Policy
- Health Services Research
- Medical Technology Assessment
Background:
- The Centers for Medicare and Medicaid Services (CMS) utilizes Coverage with Evidence Development (CED) to grant coverage for new items/services.
- CED aims to expedite patient access and collect crucial data on new medical technologies for Medicare beneficiaries.
- Despite its goals, CED implementation faces challenges impacting its effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of the Coverage with Evidence Development (CED) policy.
- To identify key issues hindering the realization of CED policy goals.
- To propose a roadmap for improving CED policy implementation and outcomes.
Main Methods:
- Analysis of the implementation of the Coverage with Evidence Development (CED) policy by the Centers for Medicare and Medicaid Services (CMS).
- Identification of specific challenges in CED application, including criteria, data collection burdens, and process clarity.
- Development of a strategic roadmap to address identified issues and enhance CED policy effectiveness.
Main Results:
- CED policy implementation faces challenges including unclear criteria, clinician burdens, and lack of process clarity.
- Inconsistent application of CED has led to limited access for some beneficiaries and insufficient data collection.
- A roadmap is proposed to refine CED application, potentially expanding its use.
Conclusions:
- The current implementation of CED by CMS requires significant improvements to achieve its intended goals.
- Addressing identified issues in CED policy can enhance patient access and evidence generation.
- Reforming CED could improve healthcare innovation adoption and patient outcomes within Medicare.
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