Using comparative effectiveness research to pay equally for equivalent outcomes: an evaluation of a multi-stakeholder effort focused on prostate cancer treatments
- Collection:
- Health Policy and Services Research
- Author(s):
- Emond, Sarah K., author Reed, Sarah Jane, author Pearson, Steven D., author
- Contributor(s):
- Institute for Clinical and Economic Review, issuing body.
- Publication:
- [Boston, MA] : Institute for Clinical and Economic Review, [2013]
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Outcome Assessment (Health Care) -- economics Prostatic Neoplasms -- prevention & control Prostatic Neoplasms -- therapy Reimbursement Mechanisms -- economics Comparative Effectiveness Research Health Care Reform -- economics Current Procedural Terminology Pilot Projects Program Evaluation Quality Indicators, Health Care -- classification Recurrence Surveys and Questionnaires Humans United States
- Genre(s):
- Technical Report
- Abstract:
- Policymakers are faced with the challenge of improving value in the healthcare system while ensuring patients have access to high quality care. Increasingly, stakeholders are looking toward comparative effectiveness research to inform efforts to improve value by paying equally for equivalent outcomes. A multi-stakeholder initiative in Massachusetts attempted to enact this principle by changing reimbursements for prostate cancer treatments. Ultimately, the effort failed due to several factors, including misalignment of goals between payers and providers; competing priorities among quality improvement leaders at provider organizations; and decreasing emphasis on fee-for-service payment arrangements. Policymakers can improve the chance for success with similar projects by ensuring engagement from leading employer groups; being clear about the business case for change from the outset; and by emphasizing how the initiative's goals align with broader system as well as internal organizational change. Policymakers and stakeholders are increasingly aware of the need for bold approaches to improve the value of healthcare delivered in the U.S. Payment reform programs that focus on changing how and how much clinicians are paid for certain services have been the focus of many recent initiatives. Often in the U.S. healthcare system, provider reimbursement is high for interventions that produce similar outcomes to less expensive alternatives. In these cases, some policymakers have called for leveling payment to remove the incentive for physicians to use more expensive, yet not more effective technologies. In Massachusetts, a regional stakeholder coalition endeavored to change reimbursement for the treatment of low-risk prostate cancer based on the results of comparative effectiveness research (CER). The goal was to use CER evidence to change payment for specific services to reflect relative effectiveness while reducing incentives for clinicians to provide equally effective but more expensive options. In this paper, we report the results of an evaluation of this effort. The Institute for Clinical and Economic Review (ICER) performed a series of qualitative interviews with the key participants from the project. Interviewees were selected if they worked directly on implementation efforts for the project, led the strategic direction of the coalition, or supervised those working on implementation. A total of 12 people were contacted and 10 people were interviewed. Of the 10 interviewed, three were providers, five were payers, one was a business consultant and one was an employer representative. ICER conducted semi-structured interviews over the phone during November and December 2011. All participants were sent the questions in advance and verbal informed consent was obtained at the beginning of each interview. ICER analyzed the interview notes to discern major themes concerning the facilitators and barriers of the group's attempt to use CER to improve value in the system. The major themes that emerged from the interviews and lessons for policymakers are described in the Evaluation section.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (15 pages))
- NLM Unique ID:
- 101634782 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101634782