organizing and delivering care. The assessment of comparative value should begin by leveraging department-wide data sources in conjunction with supportive evidence from providers, payers, and health researchers.5


Better coordination is needed to leverage the comprehensive data collected by the CMS, Food and Drug Administration (FDA), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and other government agencies, as well as the data collected by nongovernmental payers, providers, and researchers. Improved coordination would allow existing data to be used more effectively in assessing the value (costs and benefits) of health services. Consideration also must be given to the methodological limitations of studies. For example, study designs such as randomized controlled trials and observational studies provide valuable population-level information but do not always provide definitive direction for care at the individual patient level. Despite these limitations, best available evidence can be used to inform policy decisions and the development of clinical guidelines. This can result in a better understanding of which policies produce improved outcomes and fewer unnecessary costs—ultimately increasing the value of the health care system.

Assessing the comparative clinical and cost-effectiveness of different health services and organizational and delivery arrangements need not create a rigid system that limits choices for patients, providers, and health systems. Indeed, the particular situations of individual patients and communities always have to be taken into account in making decisions about clinical care and organization of services.6 (See Box 4-1 for a brief description of “value” in health care.)


The committee did not reach consensus on recommendation 3a. Although the majority of the committee supports the language of the recommendation, David Beier, J.D., Senior Vice President of Global Government and Corporate Affairs, Amgen; Kathleen Buto, M.P.A., Vice President, Health Policy, Johnson & Johnson; and Myrl Weinberg, C.A.E., President, National Health Council, did not agree with the majority’s view and provided dissenting opinions, which can be found in Appendix F. They were unable to agree on a common statement.


For patients, this means consideration not just of their clinical situation, but also of their unique preferences, concerns, and expectations that are brought to a clinical encounter and that must be integrated into clinical decisions if the patient is to be well served.

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