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Stakeholders urge comparative effectiveness to reform U.S. healthcare

By Diana Manos

Comparing the effectiveness of various drugs, treatments and devices will be the key to reigning in out-of-control healthcare costs, according to top healthcare leaders who spoke Dec. 4 at the eHealth Initiative's Fifth Annual Conference.

Gail Wilensky, senior fellow at Project HOPE and former Health Care Financing Administrator, said the way Medicare is structured today, "it is impossible to be efficient." Wilensky is also the former chair of the Medicare Payment Advisory Commission.

What America needs is comparative effectiveness of bundled treatments needed for a single condition. Medicare shouldn't pay for one treatment or intervention at a time, she said.

Wilensky called it a dynamic process where "the role of IT will very much be that of an enabler." The idea is to reward doctors who provide high quality care at lower costs. Data on best practices will be compared and conveyed via healthcare IT.

Wilensky predicted support from Congress and the Obama administration for comparative effectiveness, but said it would likely come in incremental legislative packages.

Under the Bush administration, Department of Health and Human Services Michael Leavitt has pushed value-based healthcare similar to the comparative effectiveness mentioned at the eHealth Initiative Conference.

Though the private sector supported Bush's value-based healthcare principles, legislative efforts to move the concept forward were limited.

"It's been a long ride, but maybe this will be the year it will actually happen," Wilensky said.

Wilensky's push for comparative effectiveness was mirrored by other speakers at the eHealth conference.

Mark McClellan, MD, director of the Engelberg Center for Health Care at Brookings Institution and former administrator for the Centers for Medicare & Medicaid Services, said healthcare IT must be coupled with any effort for healthcare reform based on cost and effectiveness comparison.

More evidence is needed on what care is most effective, and healthcare interoperability will also be needed to facilitate the transformation, McClellan said. Most likely, a single federal entity will not spearhead comparative effectiveness, but the American Health Information Community successor will play a vital role.

McClellan said providers will need incentives or possibly federal funding to help purchase healthcare IT in order for a comparative effectiveness plan to work.

Janet Corrigan, president and CEO of the National Quality Forum, a non-profit collective of 350 organizations, said healthcare quality is not improving at an acceptable pace and the U.S. "still has the same fragmented, clunky delivery system."

NQF will work over the next year to establish measurements for reporting care outcomes and will push hospitals and doctors to establish more integrated healthcare technology systems. "We simply cannot do this without robust technology," Corrigan said.

Corrigan predicted that over the next five years, performance measurement reporting and clinical decision support will grow at an aggressive pace.

Right now claims data is the main source of information for comparing treatments, but NQF is pushing widespread use of electronic health records. "It's not too far off when we hope to pull the plug on claims data users and say, you have to get on this IT train," Corrigan said.