Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

How can the results of Comparative Effectiveness research be turned into more valuable benefit packages?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

NIH (and other federally funded) Comparative Effectiveness databases or research conclusions that exist about tests and treatments with resulting outcomes, accuracy, cost, and recidivism.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Senior: This benefit could best be used in Medicare Accountable Care Organizations (ACO) where specified providers offer the same care package to a set number of Medicare members.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Those patients with one or more Chronic Conditions. To maximize benefits in terms of cost savings and quality/comfort improvements, seniors with Chronic Conditions - Asthma, Diabetes, Chronic Heart Failure, Depression, Chronic Pain, and combinations of these diseases.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Greater comfort for patients - better prevention, lower diagnosis escalation, perhaps fewer side effects or harmful drug interactions,

Describe any health-related risks, side effects, or harms that you are concerned about.

N/A

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Depression and other mental health disorders
• Diabetes mellitus
• Pulmonary disease/asthma

AHRQ Priority Populations

• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicare

Importance

Describe why this topic is important.

Comparative Effectiveness research represents an opportunity for the federal government to increase quality and safety while honing in on cost waste. That is also the stated goal of these ACO's. But those goals can only happen when baseline databse of "per dollar" cost measurements are created. At that point, CMS can pay more accurately for the health product and motivated ACO physicians can connect electronically to the information they need.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I have developed health benefits and programs for twenty years. Most recently, I put together a Health Systems Certificate program for the University of California. When teaching the Economics course, I created a model for reform that was based partially on the idea that improvements in treatments and tests should fall closer to the increases in costs.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Actually, this might present an alternative to further declines in Physician Reimbursement. Technically we are not going to rule out other care. Just develop a system of priorities calibrated with different levels of copay, perhaps from the provider. Motivated physicians - especially ACO doctors dealing with one population with one benefit - will be more inclined to use the more Valuable tests and treatments (e.g. Value=Quality/Cost Unit)

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Many ways - My group is helping groups of providers to form ACO's to directly contract with Medicare. We can more easily build that around an existing Medicare benefit, or at least the structure. The same holds true when my group develops in inter-provider Electronic Health Record.

Describe the timeframe in which an answer to your question is needed.

In 2011 - Medicare will start contracting with ACO's in January of 2012. Knowing Medicare benefit parameters or at least intentions will save much time and money for those provider groups who are trying to prepare now.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

This will affect the senior population but will distribute risk more fairly. It's no fun getting unnecessary tests and treatments.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Many ways - My group is helping groups of providers to form ACO's to directly contract with Medicare. We can more easily build that around an existing Medicare benefit, or at least the structure. The same holds true when my group develops in inter-provider Electronic Health Record.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program