In closing, I believe that additional recommendations focused on key drivers of costs, such as improved management of chronic disease and changes in the current fee-for-service reimbursement system, would put in better perspective the role of comparative effectiveness research in improving the effectiveness and efficiency of the health care system.

The charge to the Institute of Medicine (IOM) from Congressmen Waxman and Davis was to undertake a study of “whether HHS is ideally organized to meet the public health and health care cost challenges that the nation faces” and to focus on the missions and organization of the individual agencies. I believe a more appropriate recommendation for improving HHS’s leadership in advancing comparative effectiveness research might be to focus first on what HHS can do almost immediately:

The secretary should drive improvements in health care in the United States by leveraging the comprehensive data collected by the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention to assess real-world comparative effectiveness of medical interventions and procedures, preventive and treatment technologies, and methods of organizing and delivering care.

This HHS initiative would complement consideration of legislation to establish a comparative effectiveness entity. The current recommendation to pair cost-effectiveness with a national comparative effectiveness capability is a polarizing issue that could undermine broad consensus in favor of a concerted national effort to support this research.


Dissenting Opinion of Myrl Weinberg, C.A.E., President, National Health Council


In the chapter “Increase Efficiency and Effectiveness of the U.S. Health Care System,” the committee recommends:

3a. The secretary should work with Congress to establish a capability for assessing the comparative value—including clinical and cost-effectiveness—of preventive and treatment



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