ing the health of the nation,” it saw an important potential role for the Centers for Medicare and Medicaid Services (CMS) in providing leadership on issues of evidence-based care and creating a value-driven system—arguably the most promising current approach to the problems of rapidly rising health care costs and shortfalls in quality.

KNOWING WHAT WORKS: ESTABLISHING VALUE IN HEALTH CARE

An IOM committee has recommended a multipart national program to identify which diagnostic, treatment, and prevention services really work and under what conditions (IOM, 2008).2 This work originates from recognition that many health care practices need closer scrutiny. On one hand, patients often do not receive services that are known to be effective and appropriate.3 On the other, new technologies or certain patterns of care may be adopted without knowing whether they are the most effective.

Evidence is compelling that Americans receive a substantial amount of care that is inappropriate. Two decades of studies by a team of Dartmouth College researchers have shown large differences from one geographic area to another in care patterns, such as the frequency with which patients receive certain surgical operations or are admitted to intensive care units (ICUs). These differences are not associated with characteristics of the patients themselves but attributable almost entirely to differences in the way local doctors practice and the supply of clinical resources—hospital beds, ICUs, high-tech equipment, and specialist phy-

2

Legislation on this topic is currently pending in the 110th Congress, including the Comparative Effectiveness Research Act of 2008 (S. 3408, introduced August 2008), which would establish a nonprofit corporation, the Health Care Comparative Effectiveness Research Institute; the Children’s Health and Medicare Protection Act (H.R. 3162, Sec. 904, passed the House August 2007), which would establish a Center for Comparative Effectiveness Research within the Agency for Healthcare Research and Quality (AHRQ); and the Enhanced Health Care Value for All Act (H.R. 2184, introduced May 2007), which charges a Comparative Effectiveness Advisory Board, led by the director of AHRQ, to determine whether one or more AHRQ-sponsored federally funded research and development centers should be created to conduct and review comparative effectiveness research within two years of the act’s passage.

3

An often-cited study showed that, in general, Americans receive only about 55 percent of the care recommended for their condition or situation (McGlynn et al., 2003).



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