Better evidence on comparative effectiveness must be a priority, but we also need to acknowledge the challenges in obtaining timely, patient-relevant evidence. For example, patients currently receive recommended, effective treatments only about half of the time (McGlynn et al., 2003). Thus far, having evidence on what works has not resulted in closing the substantial gaps between evidence development and its application at the bedside; one study estimates that 17 years pass before published research is translated into practice (Balas and Boren, 2000). We must find new, more effective ways to move the results of research into clinical practice.

Undertaking assessments of the value of services to treat specific diseases could be accomplished by an existing government agency, a newly formed one, a quasi-government organization, or some type of public-private partnership (CBO, 2007). The effort should leverage current private and public agency research efforts, such as those of the Agency for Healthcare Research and Quality (AHRQ), which already supports some studies comparing technologies and styles of medical practice, and for which the committee recommends a larger budget in recommendation 2. There are many management choices regarding governance and oversight, but the first step is to support research on “what works” as the best hope for improving quality and efficiency in the near future and certainly an important component of long-term system reform.

AHRQ is working closely with other units of HHS to fulfill the goals of HHS Secretary Leavitt’s Value-Driven Health Care Initiative. This initiative requires federal agencies that administer or support health insurance programs to provide information on the cost and quality of health care and collaborate on strategies to do the following:

  • Connect data throughout the system, by adopting interoperable health information technologies and strategies.

  • Measure and make available information on the quality and costs of health care services.

  • Align incentives so that payers, providers, and patients benefit when care delivery is focused on achieving the best value of health care at the lowest cost.

Medicare and Medicaid officials (and those of other government payment programs) should use the results of comparative effectiveness studies to inform, but not dictate, their coverage decisions. CMS leadership will positively influence other payers to gravitate to evidence-based practices, and payers can create incentives for health care providers and



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