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Adopting New Medical Technology (1994) / Chapter Skim
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8. KAISER PERMANENTE'S NEW TECHNOLOGY COMMITTEE: COVERAGE DECISIONMAKING IN A GROUP MODEL HEALTH MAINTENANCE ORGANIZATION
Pages 101-108

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From page 101...
... LAIRSON A few years ago Alain Enthoven asked me to give a presentation to one of his classes at Stanford University on how the Kaiser Permanente Program made decisions related to the coverage of emerging new medical technologies. Alain knew that I was chairman of the program's New Technologies Committee, and I believe that he expected a discussion of a sophisticated decisionmaking process that carried a heavy dosage of cost-effectiveness analysis.
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From page 102...
... An example would be the Bone Marrow Transplantation Committee in our Northern California region, which tracks and advises the Interregional Committee on bone marrow transplant indications. THE NEW TECHNOLOGY COMMITTEE In 1984, because of the explosion in emerging new technologies and because government and large national employers looked upon Kaiser Permanente as one nationwide program and not 12 independent plans, the New Technologies Committee was created to recommend to the 12 regions when and how emerging new medical technologies should be covered.
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From page 103...
... These occupy more and more of our attention as genetically engineered drugs and drugs that are extremely expensive, such as Ceridase, are developed under the Orphan Drug Act. We usually, but not always, follow FDA approval; the exceptions are likely to occur because, although FDA looks at safety and efficacy, it doesn't look at relative efficacy.
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From page 104...
... Committee members are also kept aware of- emerging technologies that may be coming to the committee in the future. In gathering information, a particular technology or drug will often be assigned to one of our regional committees, such as the Bone Marrow Transplantation Committee or the chiefs of a particular department, to be discussed at their regional or interregional meetings.
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From page 105...
... We do not do this assessment of "old" or existing technologies at the present time on a program-wide basis at Kaiser Permanente, but rather, these decisions are made by the individual regions and are driven mostly by the practice preferences of individual medical groups and their evaluations of existing technologies. We have had numerous discussions of a centralized review of existing technologies, and we may, like the Blue Cross and Blue Shield Association, move in that direction.
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From page 106...
... Because of the number of requests from within the program to consider individuals and individual decisions, the Kaiser Permanente Program established a separate but interrelated committee, the Situation Management Committee, in each region to make recommendations related to how a coverage policy should be applied to an individual patient. If a region had a question related, for example, to a specific patient and a specific organ transplan
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From page 107...
... CONCLUSION The issues related to the adoption and use of emerging medical technologies are obviously complex. Who will develop new technologies, who will pay for them, and who will receive them are critical societal issues.
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From page 108...
... health care system uses technology. Until there are some clearer guidelines of how society wishes to manage the costs of care and the resources it is willing to devote to health care, individual providers and insurers must continue to struggle with the questions that arise from the application of and economic costs of new medical technologies.
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Key Terms

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  • permanente program
  • technology committee
  • fda approval
  • medical technologies

  • experimental exclusion
  • particular technology
  • permanente medical
  • management committee
  • existing technologies

  • coverage decisions
  • situation management
  • bone marrow
  • hmo act
  • decisionmaking process

  • individual patient
  • health plan
  • individual regions
  • regional committees
  • marrow transplantation

  • transplantation committee
  • broad policy
  • individual physician
  • decisions related
  • employee assistance

  • specific organ
  • independent permanente
  • ago alain
  • orphan drug
  • makes broad


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