John Santa MD MPH, Health Advisor/Consultant April 2008

2 The Problem Half of what doctors do is evidence-based. Unnecessary care harms patients and wastes $$$. System poorly organized for comparing treatments and providers. Consumers are lost in the maze. Conflict-of-interest is rife in health care. Doctors lack information to make the best possible clinical decisions. Consumers lack information to choose among treatment and provider options.

3 Barriers to Change Comparative effectiveness research is very expensive. Aggregation of data and findings is hard. Data is inconsistent across states, health plans, benefit designs. Some companies resist sharing data. Doctors are hard to reach and influence. Consumers are skeptical, worry about access being blocked. Some industries fanning consumer fears.

4 Our mission since 1936 … an expert, independent, nonprofit, nonpartisan organization, whose mission is to work for a fair, just, and safe marketplace for all consumers. What we do: test, inform and protect. Consumer Reports

5 Consumers want trustworthy, easy-to- understand, actionable information. No commercial agendas, advertiser influences or financial relationships. Involve consumers from the outset in choosing topics for evaluation and effective translation methods. Work with advisors and groups who are independent and unbiased. Consumers love ratings! Our Approach

6 Our Health Ratings to Date Health Plans Nursing Homes Health Care Products & Devices Nutritional Supplements Medical Treatments Prescription Drugs

8 What We Found Cholesterol Drugs – For most people, new generics are just as good. Alzheimer’s Drugs – Not very effective in preventing mental decline. Diabetes Drugs – Newer, expensive medications are no better and less safe. Heartburn Drugs – Over-the-Counter drugs just as good as expensive brands.

9 Millions view information on or other partner Web sites. Medco uses CRBBD content. In one initiative, 4.3% of statin users switched to lower-cost generics. Savings: $8 million. The Wisconsin Education Association Trust also used CRBBD materials. Savings: $455,000 from switch to lower-cost heartburn drugs.

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11 Policy Issues Need reliable source of ongoing funding for comparative effectiveness research. Test ways to incorporate comparative effectiveness into benefit design and reimbursement. Target funding at consumer friendly “translations” and dissemination. Payment reform must reward providers for using evidence-based practices. Explore tiered co-pays to reward consumers for choosing evidence-based care.

12 Policy Issues Eliminate conflict-of-interest at critical decision points (training, research, regulation, purchasing, point of care). Create more conflict-free independent “islands” of health research and delivery, like DERP and AHRQ’s Evidence-Based Practice Centers. Educate consumers on what “transparency” really means to them. Deploy HIT & e-Rx to dramatically improve patient safety.