The New Health Dialogue

If we want to improve quality and control costs in our health care system, we need verifiable, reliable information about what works and what doesn’t. Comparative effectiveness research (CER), which compares two or more medical treatments, tests, or interventions to see which one works better for patients, is the key to figuring this out.

The journal Health Affairs themed its October issue around the “new era” of comparative effectiveness research. The health reform law advances CER by establishing the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity that will establish research priorities, set the agenda, and provide for research to be carried out. The GAO recently announced the members of the PCORI Board of Governors. (The GAO is home to the Comptroller General, who was in charge of board appointments).

The journal explores the national strategy around health reform and CER (how do we set priorities and make effective use of this information?), the methodology of CER (what are the most effective strategies for structuring and conducting research?), stakeholder, patient, and clinician concerns (how do we distribute this information to those who need it?), cost concerns, and of course the politics of CER. The issue also offers insight into public opinion on CER through polling data -- a recent national survey found that Americans rated CER favorably at an average rate of 61.9/100, but were opposed to utilizing CER for cost or coverage determinations.

An article by our Program Director, Kavita Patel, looks at the journey that took comparative effectiveness policy from idea to reality, and offers insight into the stumbling blocks and solutions that propelled CER from behind the scenes. A subscription is required to view Health Reform’s Tortuous Route to the Patient-Centered Outcomes Research Institute in its entirety, so we’ll just give you a quick rundown:

• The switch from a Republican to a Democrat-controlled Congress spurred legislative activity around comparative effectiveness research in 2007. A key policy predecessor to PCORI was H.R. 3162, the Children's Health and Medicare Protection Act -- it called for the establishment of a “Center for Comparative Effectiveness Research” inside the Agency for Healthcare Research and Quality (AHRQ.) Momentum continued during the 2008 election, when both Obama and McCain spoke favorably about CER.
• After the early 2009 battle over the economic stimulus (which contained $1.1 billion for CER), the prospect of bipartisan for broader health reform legislation with a CER component became increasingly unlikely. In the summer of 2009, the Senate HELP Committee and the three House committees writing health reform bills came out with legislation that would house a CER entity in AHRQ. But after the raucous town hall meetings of August, Senate Finance Committee staffers realized that a transparent process and a more private entity could be vital to the survival of CER.
• The more private entity, PCORI, won out during negotiations to draft the final Senate bill, the Affordable Care Act. The Senate bill ended up being the version of health reform passed into law because of several factors, the sudden election of Massachusetts Republican Scott Brown to the Senate foremost among them. However, the article also explores the theoretical outcomes of negotiations to merge the House and Senate health care bills, if Brown had not won.

For a far more detailed analysis and more on the “behind the scenes” of health reform, check out the full article.