1. COMPARATIVE EFFECTIVENESS RESEARCH Public Policy Interest and Issues Jeanne Lambrew, PhD Associate Professor LBJ School of Public Affairs National Health Policy Conference February 4, 2008

2. 2 OVERVIEW Public Policy History Private Sector Interest Recent Legislation Issues Prospects

3. PUBLIC POLICY HISTORY: United States Part of health services research –AHRQ as the lead agency –Fraction of funding across agencies Not so new –Technology assessment –Outcomes research 3 Funding (Millions) for Agency for Healthcare Research and Quality (AHRQ) Dedicated Funding to Comparative Effectiveness

4. 4 Efforts in Other Nations Great Britain: National Institute for Health and Clinical Excellence (NICE) –Government-based –Conducts syntheses of comparative clinical and cost effectiveness –Existing and new therapies –Budget: $60 million Germany: Institute for Quality and Efficiency –Independent, funded through levy Australia and others: Condition for drug, device approval

5. 5 PRIVATE SECTOR INTEREST Payers & Insurers Business support –Business Roundtable –National Business Group on Health –Better Health Care Together (Wal-Mart –SEIU Business-Labor Coalition) –Key individual firms (e.g., GM) Insurer support –Blue Cross Blue Shield Association –America’s Health Insurance Plans –Key individual insurers (e.g., Kaiser)

6. 6 Providers & Patients Provider support –Institute of Medicine –Certain societies (e.g., American Academy of Family Physicians) Consumer support –AARP –Consumers Union –Labor unions Coalitions –Coalition for Health Services Research –Alliance for Better Health Care

7. 7 RECENT LEGISLATION New Authority in 2003 Offered as Frist-Clinton amendment in 2003 Enacted as part of the Medicare prescription drug law (P.L. 108-173, Sec. 1013) –Authorized $50 million for AHRQ –For syntheses of information to improve Medicare, Medicaid and SCHIP –Promotes transparency, dissemination Funded at $15 million per year for FY 2005-2007, $30 million for FY 2008

8. 8 Allen-Emerson Bill of 2007 Introduced as “Enhanced Health Care Value for All Act” (H.R. 2184) Major provisions –AHRQ-based authorization for a center –New stakeholder advisory commission –Funding from Medicare and, eventually, private insurers Other provisions –Coordinating council for health services research

9. 9 CHAMP Act of 2007 Included in House-passed bill (H.R. 3162) Major provisions –AHRQ-based center –Authorized to spend $300 million for 2008-10, $375 million afterwards –Funded by Medicare and fee of $2 per privately insured person in 2011 and beyond Congressional Budget Office: –Federal Spending: +$2.4 billion over 10 years –Federal Savings: -$1.3 billion over 10 years Fully offset by 10 th year –System-wide Savings: -$6 billion over 10 years

10. 10 ISSUES: Scope Breadth of studies funded –Clinical comparisons –Cost comparisons –New services versus existing ones Type of studies funded –Randomized control trials –Secondary data analyses –Syntheses –Other

11. 11 Funding Amount: –Millions or billions Currently $30 million of $339 billion budget Some propose $5 billion per year Sources: Public versus private –Discretionary funding –Mandatory (e.g., Medicare) funding –Private support –Unfunded mandate

12. 12 Governance & Placement Who makes what decisions –Priorities –Methods and transparency –Use of output Placement of funding –AHRQ – or different / new agency –Public-private partnership (e.g., Federally- Funded Research and Development Centers (FFRDCs)) –Quasi-governmental entity (e.g., Institute of Medicine) –Non-profit (e.g., CDC Foundation)

13. 13 PROSPECTS Scope Medicare legislation in 2008 Presidential candidates –Clinton: Best Practices Institute Funded by private and public sector Compare the effectiveness of alternative treatments –Obama: Establish an independent institute Guide reviews and research on comparative effectiveness –McCain: Make public more information on treatment options Facilitate the development of national standards for measuring and recording treatments and outcomes Dedicate federal research on the basis of sound science

14. 14 SOURCES OF INFORMATION Institute of Medicine. (January 2008). Knowing What Works in Health Care: Roadmap for the Nation. Washington, DC: National Academies of Science. Congressional Budget Office. (December 2007). Research on the Comparative Effectiveness of Medical Treatments. Washington, DC: CBO. Wilensky, G.R. (November 7, 2006). “Developing a Center for Comparative Effectiveness Information,” Health Affairs Web Exclusive, w-572–w-585. AcademyHealth. (September 2005). Placement, Coordination, and Funding of Health Services Research within the Federal Government. Washington, DC: AcademyHealth.