The Role of Purchasers and Payers in the Clinical Research Enterprise Workshop Summary (2002) / Chapter Skim
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1 The Role of Purchasers in the Clinical Research Enterprise
1 The Role of Purchasers in the Clinical Research Enterprise
Pages 9-28
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From page 9... ...
Medical Director, Managed Care, Health Care Initiatives General Motors Corporation in conjunction with The Permanente Company This part of the workshop deals with the perspective of private purchasers, a perspective not often included in in-depth discussions related to clinical research. The goal is to understand how the Clinical Research Enterprise can better serve purchasers as they strive to provide high-quality, affordable health care benefits to employees, retirees, and dependents.
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From page 10... ...
We are pleased that current therapeutic interventions are largely focused on the those conditions identified in the Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century (Committee on Quality of Health Care in America, Institute of Medicine, 2001) that account for about 80% of health care spending
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From page 11... ...
Purchasers, and the country's The country's health care system as a whole, would greatly benefit from health services research that would help to define mechanisms by which purchasers, plans, and payers could encourage not merely the broad adoption of evidence-based clinical guidelines, but also their integration into the day-to-day delivery of health care services. Gregg Lehman health care system as a whole, would greatly benefit from health services research that would help to define mechanisms by which purchasers, plans, and payers could encourage not merely the broad adoption of evidence-based clinical guidelines, but also their integration into the day-to-day delivery of health care services.
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From page 12... ...
Development of metrics that would differentiate physician, hospital, and other health care provider performance · Identification of incentive systems that would "reward" optimal provider practice, and similarly, identification of incentive systems that would encourage employees to proactively manage their own health and to seek care (preventative, episodic, and chronic) from top-performing providers · Creation of metrics to quantify the impact on worker productivity of high-quality health care that is delivered in accordance with evidence-based clinical guidelines.
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From page 13... ...
Bruce Taylor Helen Darling President Washington Business Group on Health As seen in the latest debate about the utility of mammography guidelines, fundamental research performed years ago was often not conducted in a way that allowed answers to basic questions. Today purchasers want new technologies and treatments to have been proven efficacious based on high standards of clinical empirical evidence.
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From page 14... ...
The Clinical Research Enterprise provides more innovation, more new technology, and more new drugs than any enterprise in the world. Purchasers are more than willing to help disseminate information on best clinical practices and reward hospitals, physicians, and others who are willing to meet best-practice standards.
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From page 15... ...
In this regard, more head-to-head comparisons of the value of new versus existing therapeutic agents could help purchasers make more rational benefit design decisions. Jill Berger Corporate Health and Welfare Manager Marriott International Many purchasers are again experiencing double-digit inflation in medical costs, which is a large concern for Marriott.
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It is important for purchasers to consider the health care information that ultimately filters down to the user level. Tomorrow, employers may not be the ones who choose health plans for their employees.
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Gregg Lehman . Provider performance using evidence-based clinical guidelines · Relative effectiveness of health plan interventions in changing physician practice patterns · Impact of employee interventions in eliciting the desired behavior · Potential mechanisms to support use of project data to support valuebased purchasing The important outcome of this project is guidance on realignment of incentives.
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From page 18... ...
guidelines and recommendations are constantly changing. Dale Whitney CHALLENGES FOR PURCHASERS IN THE CLINICAL RESEARCH ENTERPRISE Patricia Salber, M.D., M.B.A Purchasers seem to be "marching to a different drummer" than academic researchers because of the urgency of their need for answers to the questions that they face, particularly in light of double-digit inflation of health care costs in the context of an economic downturn.
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Several times a year a representative from a pharmaceutical company promotes drug-based disease management programs at UPS. It is difficult to evaluate a program in which most evidence for its utility is from studies funded by the pharmaceutical industry.
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From page 20... ...
Chairman of Pediatrics and Director of Medical Genetics Birth Defects Center Cedars Sinai Medical Center Genomics will pose new challenges for purchasers in coming years. Purchasers want good productivity indices and more value for their health care dollar; yet they are frustrated because the research studies coming out are nonuniform or ambiguous.
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From page 21... ...
Speaker Response to the Enterprise Coordinating Activity Proposal Helen Darling of the Washington Business Group on Health began the discussion by noting that the concept of a national Clinical Research Enterprise coordinating activity is a good one. She commented that purchasers are changing their role, and that they cannot simply be reactive in the current environment.
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From page 22... ...
of the National Business Coalition on Health stated that is it hard to argue with a multistakeholder approach to problem solving and concurred that it is a laudable idea. He suggested that the National Quality Forum be a key player in this approach and proposed that a number of roundtable members sit on the purchaser council of the forum.
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From page 23... ...
Plans can send out all the fliers they want, but if they cannot change the environment The issue goes beyond what a health plan can provide. Plans can send out all the fliers they want, but if they cannot change the environment in which the individual makes lifestyle decisions, they will not be able to reinforce the switch to healthier behaviors.
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From page 24... ...
Medical Director and Chief Health Officer HealthPartners Prevention is a cost issue for employers as well. For example, employees at the extreme of the body mass index chart, at 35 or 40, may incur substantial costs associated with bypass operations needed to treat heart conditions related to diabetes.
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From page 25... ...
Some questions discussed are, how do you use the health care system, how can we best help you to use the health care system, and what do we need to change in the way we provide benefits? PUBLICATION OF A RESEARCH PRIORITIES PROPOSAL Richard Rettig of RAND started a discussion regarding publication of a clinical research priorities proposal by noting that an asset for purchasers and payers is an immense amount of claims data, which provide a running account of the annual burden of disease in this country.
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From page 26... ...
SUMMARY The goal of the session on the role of purchasers in the Clinical Research Enterprise was to shed light on how the Clinical Research Enterprise can better serve purchasers as they strive to provide high-quality, affordable health care benefits to employees, retirees, and dependents. Representatives from corporations (General Motors Corporation, United Parcel Service, Marriott International, and William M
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From page 27... ...
Finally, they considered the usefulness of compiling and publishing a list of clinical research projects that purchasers and payers consider top priority.
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