– Funding will support work with payers and provider groups to explore translation of comparative effectiveness research results into changes in provider reimbursement –
Boston, Mass., July 15, 2011 – The Institute for Clinical and Economic Review (ICER), a leader in comparative effectiveness research based at the Massachusetts General Hospital’s Institute for Technology Assessment, has been awarded a payment reform research grant from the Robert Wood Johnson Foundation. The grant will support ICER’s work with a coalition of payers and provider groups in Massachusetts to design a payment reform initiative to reduce the overuse of more expensive medical treatments for localized prostate cancer that offer no significant clinical advantages over other effective alternatives. The payment reform initiative is part of a broader effort that combines payment changes with the feedback of information on clinical practice variation to clinicians and a new community-wide patient education program for patients with localized prostate cancer.
Patients with localized prostate cancer have numerous care options from which to choose, including active surveillance, prostate surgery, and different forms of radiation therapy. ICER’s comparative effectiveness appraisal of these treatment options determined that the evidence is sufficient to conclude that most of these management options provide comparable outcomes, whereas payments for some are two to five times greater than equally effective options. ICER has been working with the Employers Action Coalition on Healthcare (EACH), composed of leading employers, employers groups, health plans and provider groups in Massachusetts, to use these results to design new web-based patient education materials and potentially align payment changes that would reduce payment disparities and come closer to the goal of paying equally for treatments that achieve equivalent patient outcomes.
“Building on the strong foundation of our previous work with the key members of the EACH initiative, ICER is poised to study the effort to restructure provider payments to better reflect the evidence on actual patient outcomes,” said Steven D. Pearson, MD, MSc, FRCP, President of ICER. “Our assessment of all the existing evidence showed that the four most common management options for low-risk prostate cancer deliver comparable outcomes in terms of disease recurrence and survival. There are some differences in the rates of common side effects, and the choice of treatment option should therefore be driven largely by well-informed patients discussing with their clinicians how they value these different risks. This funding from Robert Wood Johnson will allow us to learn whether payment changes, framed as part of a broader program of clinician and patient engagement, can support a more individualized approach to treatment by removing perverse incentives that drive the cost of healthcare higher without providing better outcomes.”
The overall goal of the research project is to seek the views of all key stakeholders on what lessons can be drawn from this effort to use payment reform as a companion piece within a broader initiative to provide patients with better information and engage clinicians in a community-wide effort to improve the use of evidence to guide treatment decisions. The funding from the Robert Wood Johnson Foundation will support ICER’s work with the coalition to learn from this effort and will help guide better approaches to using future payment reforms to improve the quality and value of care for all patients. The funding is part of the Robert Wood Johnson Foundation’s program entitled “Developing Payment-Reform Strategies for High-Value Care.”
The Employers Action Coalition on Healthcare is a cross community coalition of payers, providers and employers in Massachusetts working together to significantly reduce the rate of increase in commercial healthcare spending by improving the value, quality and efficiency of healthcare services and delivery and by encouraging consumers of healthcare to become more active participants in and active managers of their own healthcare decisions. EACH is comprised of representatives from the provider groups at Atrius Health, Boston Medical Center, Partners Healthcare, Tufts Medical Center and Winchester Hospital; the health plans Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care and Tufts Health Plan; the employers EMC, AstraZeneca and MassMutual; and the employer and purchaser consortia Associated Industries of Massachusetts, Greater Boston Chamber of Commerce, Massachusetts Business Roundtable and Massachusetts Taxpayers Foundation. Bain & Company is also providing vital support of the EACH effort through administrative and strategic planning expertise.
The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all. ICER is also leading the New England Comparative Effectiveness Public Advisory Council to explore ways to translate federally-produced comparative effectiveness information for regional use. For more information about ICER, please visit www.icer-review.org.