The Future of Comparative Effectiveness Research
The Bipartisan Policy Center’s introductory forum on patient-centered comparative effectiveness research (CER) provided a broad overview of the field of CER, the specific challenge of disseminating research findings to patients and providers, and various solutions to solving this challenge. BPC’s second forum consisted of two separate panels. The first panel, moderated by BPC’s Bill Hoagland, featured former U.S. Sen. Kent Conrad and former U.S. Rep. Dr. Phil Gingrey and focused on the early history and concerns regarding CER legislation in the Patient Protection and Affordable Care Act (PPACA). The second panel, moderated by ECRI Institute’s Jeffrey Lerner, featured Dr. Joel Kupersmith from Georgetown University Veterans Initiatives; Dr. Donald Liss, formerly of Independence Blue Cross; Newell McElwee from Boehringer Ingelheim; and Sara Traigle Van Geertruyden from the Partnership to Improve Patient Care. This panel provided a broad overview of the current challenges and future opportunities for CER.
What were the early concerns regarding CER legislation in the Patient Protection and Affordable Care Act (PPACA)?
In 2009 when Congress was discussing the provisions of PPACA, there were significant concerns from Democrats and Republicans, including then Representative Tom Price, on the creation of a CER institute that could potentially dictate physician decisions and lead to a deindividualized focus on medicine. However, Sen. Conrad, with Sen. Michael Enzi (R-WY), compromised to address these concerns by creating the Patient-Centered Outcomes Research Institute, also known as PCORI, with the limitation that results of CER could not be used to determine coverage and reimbursement. Today, PCORI enjoys broad bipartisan support for its mission to provide providers with the best evidence-based information on treatments, while also giving them the flexibility to tailor treatments to each individual patient.
What are some challenges to CER?
The nuance of medical care presents a significant challenge. An increased focus on precision medicine in this decade has not only made patients identifiable by different characteristics but even by their genetic fingerprints. This makes the generalization of any specific clinical study to a larger population even more difficult. Providers often have difficulty determining whether a treatment, which works for a large population, works for their patient.
In current fiscal times, funding presents another challenge. However, ensuring effective use of resources can be facilitated by encouraging private sector buy-in and analyzing data collected by private stakeholders in the pharmaceutical industry and health plans in a comparative way and using public funds mostly on important topics private entities have no incentive to fund.
What are the key opportunities for CER?
We live in an era where electronic health records are nearly universal and databases cataloging information collected from biomedical research, clinical care, and public health are widely available. Thus, there is an opportunity to make robust data available and use every patient interaction as part of a pragmatic trial. While privacy concerns must be adequately addressed, there is a unique opportunity going forward to leverage data collected during medical delivery to inform improvements.
There are also key opportunities in disseminating and implementing CER by involving non-researcher clinicians and administrators. Some of the research on CER deals with research on health systems. Therefore, if health administrators are involved in planning the research, they have a greater incentive to implement the results.
How does the transition towards a value-based payment system create new avenues for CER?
Rising health care costs have incentivized many payers and providers to begin the transition towards a value-based healthcare system. This progression will hold providers accountable for patient outcomes and thus, may lead to increased receptivity and utilization of CER. Ideally, health systems that receive value-based compensation will use patient-centered CER to strike a balance between population health and individualized treatment, ultimately increasing value and decreasing utilization and costs.
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