currently does not produce an adequate volume or quality of information to support policy decision making at various levels—from employers, physician groups, government health programs, and health plans, to the ultimate end users, the consumers. Against this background, speakers from purchaser, payer, and other stakeholder organizations laid out a mosaic of views.

In the first session, The Role of Purchasers in the Clinical Research Enterprise, representatives of large employers and business organizations (General Motors Corporation, United Parcel Service, the National Business Coalition on Health, Verizon, the Washington Business Group on Health, Marriott International, and William M. Mercer Inc.) responded by describing what they need from the Clinical Research Enterprise. Speakers agreed that purchasers need the enterprise to provide them with knowledge of new technological innovations and treatments that have been proven effective through evidence from well-designed, well-executed, unbiased studies. They stated their need to understand why clinical practices vary widely and why agreed-upon practices are not uniformly performed, and they requested help in reducing this variation. They expressed their willingness to pay for quality in health care, but noted that they need to know what they will receive for their investment, either in the short-term or the long-term.

Purchasers recognized a trend toward a consumer-driven health care system in this country, and they acknowledged the important contribution that they can make in preventive health by educating their members and encouraging healthy lifestyle behaviors. They expressed interest in contributing to a national fund that would be used to examine research questions of national significance that are not currently being addressed, but they reiterated that they would need to know what the return would be for their investment. Finally, they considered the possibility of joining with payers to compile and publish a list of top-priority clinical research projects.

In the second session, The Role of Payers in the Clinical Research Enterprise, speakers from four health plans (Wellmark, HealthPartners, United Healthgroup, and Aetna U.S. Healthcare) and a representative from the American Association of Health Plans revisited many themes brought out in the purchaser session. They emphasized their need to understand what is effective and what is not in the care of patients, the prevention of disease, and the promotion of health. They discussed the need for full disclosure of information regarding research funding to the public, potential research participants, and other stakeholders. They acknowledged the need to know how to provide safer care and eliminate errors to keep members free from harm. They requested guidance on how to transform the culture of medical practice from a profession-centered, individual activity into a patient-centered, team effort. They wished for more insight into population-based community methods of improving individual and community health, and they asked for help in eliminating barriers to the delivery of interventions for behavioral change.

Payers acknowledged that the Clinical Research Enterprise provides innova



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