Frame the question for the new health technology
- Alternative therapy? (better than?)
- Adjunctive?
- Specific population?
- Reduced length of stay (LOS), less invasive?
Process: Potential Elements
1. Identify topics
2. Formulate the assessment problem
3. Retrieve available evidence
4. Collect primary data (as appropriate)
5. Interpret evidence
6. Synthesize and consolidate evidence
7. Formulate findings
8. Report and disseminate findings
9. Monitor impact
Blue Cross Blue Shield Technology Evaluation Center (TEC)
Five Criteria:
1. The technology must have final approval from the appropriate government regulatory bodies
2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes
3. The technology must improve the net health outcomes
4. The technology must be as beneficial as any established alternatives
5. The improvement must be attainable outside the investigational setting
Who Dose T/A?
Public Sector
- The Medicare, Medicaid and SCHIP Agency (CMS)
- Agency for Healthcare Research and Quality (AHRQ)
- Food and Drug Administration (FDA)
- The U.S. Government Accountability Office (GAO)
- National Institutes of Health / Medical Executive Committee (NIH / MEC)
Private Sector Payers
- Managed care organizations
- Other payers
- Medical professional societies
- Hospitals
- Academic medical centers
- Technology industry
Vendors
ECRI Institute
Blue Cross Blue Shield Association Technology Evaluation Center (TEC)
Hayes Inc.
MetaWorks Inc. / United BioSource Corporation
University Healthsystems Consortium (UHC)
International Agencies
The Cochrane Collaboration
National Institute for Clinical Excellence (NICE)
International Network of Agencies for Health Technology Assessment (INAHTA)
European Collaboration for Health Technology Assessment (EUnetHTA)
Different Perspectives
FDA (Regulator)
- Safety
- Efficacy: Benefit of using a technology for a particular health problem in ideal conditions
- Substantially equivalent or comparison to placebo
- Intermediate, short-term outcomes
Medicare (Payer)
- Experience relevant to members (65+)
- Effectiveness: Benefit of using a technology for a particular health problem in general or routine conditions
- Comparisons to standard of care
- Longer-term, health outcomes
- Operational impact (cost!)
Current Issues
- Gainsharing: Aligning physician and hospital incentives
- Pay for Performance: Rewarding quality, cost-effective performance with a financial incentive
- Stricter National Coverage Decisions (e.g. Carotid Stenting)
- Coverage with Evidence (conditional coverage)
- Willingness to ration health care (especially outside US)
[Source: lecture by Mitch Sugarman]
