Knowing What Works in Health Care: A Roadmap for the Nation

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Knowing What Works in Health Care: A Roadmap for the Nation (2008)
Board on Health Care Services (HCS)

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. "3 Setting Priorities for Evidence Assessment." Knowing What Works in Health Care: A Roadmap for the Nation. Washington, DC: The National Academies Press, 2008.

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Knowing what Works in Health Care: A Roadmap for the Nation

TABLE 3-1 Context for Setting Priorities for Evidence Assessment, 2006

Organization	Target Audience	Number of Full Systematic Reviews
AHRQ
Effective Heath Care Program	CMS, providers, policy makers, consumers	4
EPC program	CMS, USPSTF, NIH, and other federal agencies; providers; medical professional societies	22
USPSTF	Primary care clinicians, health systems, payers, and purchasers	6
Other federal programs
CMS	Medicare intermediaries, beneficiaries, and providers	9
DERP	State Medicaid programs	3
NIH Consensus Development Program	Health professionals and the public	3
Private technology assessors
BCBSA TEC	Medical directors of BCBSA member plans, providers, and scientific staff	14
ECRI Institute	Private clients, including decision makers in hospitals, health systems, health plans, and departments and ministries of health	20
Hayes, Inc.	Private clients, including decision makers in hospitals, health systems, health plans, and government agencies	86
NOTE: DERP = Drug Effectiveness Review Project; USPSTF = U.S. Preventive Services Task Force. SOURCES: AHRQ (2007c,d,e); BCBSA TEC (2007); NIH Consensus Development Program (2007).

the Centers for Medicare & Medicaid Services (CMS) on the services used by the Medicare population, sponsors evidence reviews (conducted by an AHRQ EPC) only when Medicare is considering a national coverage decision on a controversial issue.

In general, payers initiate assessments when they must make benefits and coverage decisions about new technologies or new applications of existing technologies. In this context, the decision usually involves a categorical