1. Webinar: Advanced Implementation Strategies for a Compliant Grant Process The Tipping Point: Incrementalism Need not Apply December 9, 2008
Mike Saxton, MEd, FACME
Senior Director
Medical Education Group
US External Medical Affairs

2. Should industry support of CME end?
Conversation Areas
Should industry support of CME end?
If it continues, how should it change?
Options
What steps Pfizer has taken?
Lunch
Dean mtg
Large group

3. Should Industry Support of CME End ?

4. I personally believe commercial support of CME should end within 5 years?
Yes No
Abstain
Answer Now
24 of 125

5. Relationship with Industry Collaboration or Cooperation?
“First, industry relationships are essential, but they must be carefully managed. By developing clear and well-considered guidelines, we can optimize the benefits inherent in the academic medicine-industry relationship, while at the same time, minimize the risks. In other words, we need partnerships that are principled, productive, and transparent.”
Darrell G. Kirch, MD, AAMC President and CEO
[AAMC Reporter 2008; 17(2):2]
We may not know what to call it, but we know what it looks like and for what purpose.

6. If Industry Support of CME Continues, How Should It Change?
What is its purpose?
What are the options for industry?

7. A Convergence of Interests Model for Commercial Support
Business
Needs
Healthcare Provider Performance Gaps
Patient Needs
Ideal Area for Commercial Support
Healthcare System Quality Gaps
Overlapping zones of mutual value
Accelerate adoption of new evidence based innovations that address a gap in healthcare quality
Improve patient care and shareholder value simultaneously
Win-Win Collaboration Defined By A Convergence of Interests
Tactical to strategic
Any partner might have needs in any or all of these areas.
Tactical on the outer rings between where smaller level of convergence occurs – financial only, any transaction relationship
Partnerships vs subcontracting on outer ring
Strategic – shared goal, shared risk, blended competencies,
Configuration of circles will vary by organization. Could shift circles to reflect different needs and show 3 or 4 on page. Something with high business need attached to HCS need for example.

8. Industry Perspective on Future Support Options
Option Pro Con
Maintain
Continue current approach
Less disruptive to CME providers
More familiar to industry
ACCME standards of accreditation currently not rigorous enough on organizational conflict of interest.
Change is too slow for environment
Industry criticism remains
Low educational effectiveness
Company compliance risk is highest
Eliminate
Stop industry funding completely
Reduces perceptions of bias
Helps alleviate budget pressures on industry
No ability to support credible independent education that accelerates evidence based innovation adoption
Removes a resource to help close healthcare quality gaps
Current CME system dependency – phase out over 5 years if chosen
Does not manage the majority of real conflict of interest in CME
Transform
Dramatically increase provider eligibility requirements relative to conflict of interest requirements
Increase funding for Performance Improvement CME while reducing funding dramatically for single non-interactive methods
Better educational effectiveness based on the evidence of what works
Increases collaboration
Encourages innovation
Improves compliance significantly
Supports direction of organized medicine (AMA/ACP/AAFP/et al PBLI model)
Enhances credibility
Colleagues will need to understand value of new approach and must have communication tools to handle any push-back.
Current CME system dependency on traditional update CME funding model
Internal and external pressure to still invest in some ineffective CME
“Industry funding pooled and managed by independent party”
The “pro” arguments include:
Reduces prospects of COI
Potentially less disruptive to CME providers
The “con” argument :
Industry support will be a charitable contribution at 5% of today’s funding level
No accountability for dollars provided
Less potential to influence positive change in CME practices

9. Pfizer’s New Medical Education Grant Policy
To only support providers most likely to meet the highest standards of quality and independence defined by the medical profession
To support the profession’s move towards performance-improvement initiatives that integrate education and quality
Initiate a competitive grant review period for grant applicants to encourage more innovative, high-quality grant applications
Review all major grants using criteria equivalent to ACCME’s highest level of accreditation
Redirect resources closer to the point of care in order to better meet the needs of the new model of PI-CME
To support the medical community’s call for balanced funding in CME by establishing organizational or grant dependency financial caps on commercial support
As of July 1, Pfizer will no longer directly fund CME provided by organizations who do not have patient care as their primary mission ie Medical Education and Communication companies

10. Transformation: Rather Than Why, Why Not!
More effective based on evidence in the literature
Elevates importance of patient above current model
Supports direction of ACCME, Macy, AAMC, etc
Improves industry credibility with the medical profession and the public
Significantly improves compliance
Costs less – 90% in many cases
How does it improve compliance
Focuses on outcome rather than process steps as best measure of compliance
Far less dependent on expert driven lecture based CME where relationships with faculty and focus on content are among the larger compliance risks we face
Mitigates against many of today’s conflicted compensation systems that do not conform with the Assn of Fund Raising prof code of ethics by excluding business development practices of non-healthcare aligned organizations

11. Summary The Best Form of Compliance is Quality Education
The Best Investment Is Education Most Likely To Improve Provider Performance In the Direction of Evidence that Aligns Our Interests with Those of Patients
The Performance Improvement Model of Education Accomplishes Both