1. manatt A U.S. Perspective Commonwealth Fund Alliance for Health Reform November 7, 2011 Ian D. Spatz

2. Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

3. Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

4. 45.23 liters 24.44 Liters 20.72 Liters 8.96 Liters Source: 2009 Wine Institute Wine Consumption 45.23 Liters

5. Source: FAOstat (UN) Beer Consumption 27.36 liters 102.24 Liters 102.24 liters 99.83 liters 86.08 liters

6. Obesity 9.4% 12.9% 23% 30.6% Source: OECD Health Data 2005 Percentage of population with BMI>30

7. CT Scan Abdomen $179 $374 $187 $536 Source: International Federation of Health Plans, 2010 (U.S. avg.)

8. Bypass Surgery $16,325 $27,327 $13.998 $59,770 Source: International Federation of Health Plans, 2010 (U.S. avg.)

9. Cost Effectiveness

10. Comparative Effectiveness

11. Cost Effectiveness Comparative Effectiveness Patient-Centered Outcome Research

12. Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

13. Large, Empowered Payers Express Scripts CVS/Caremark Germany France Medco UK MedImpact 90 million 85.1 million 81.5 million 65 million 63 million 32 million Atlantic Information Services, 2010

14. Multi-tier formularies Generic substitution Prior authorization Generics first Drug utilization review Risk sharing

16. Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

17. “Whether the addition of [product] to chemotherapy regimens for [type of cancer] improves health outcomes has not been established.” “It was not certain whether [product] provides enough benefit to patients to justify its high cost …, so NICE did not recommend it.” “We don’t know” “We know it doesn’t help”

18. Starting in 2013, Medicare and all private health insurance companies will pay a tax into a trust fund that will support the activities of the Patient-Centered Outcomes Research Institute Funding is estimated to reach $500 million annually by 2015

19. Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data