Cost, Evidence and Comparative Effectiveness Research Data in Benefit Design – An Exploratory Study Harald Schmidt Fellow Kolleg Forschergruppe Uni Münster Research Associate LSE Health Fellow , Kolleg Forschergruppe, Uni Münster , Research Associate, LSE Health Nuffield Trust, H3 March 11
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Cost, Evidence and Comparative Effectiveness Research Data in Benefit Design –An Exploratory Study
Harald SchmidtFellow Kolleg Forschergruppe Uni Münster Research Associate LSE HealthFellow, Kolleg Forschergruppe, Uni Münster, Research Associate, LSE Health
Nuffield Trust, H3 March 11
Objectives
• With CER push: (how) will public and private payers consider value in benefit design? g
• Implementation mechanisms: what’s feasible and fair?
• Within vs across disease prioritizations: potential?
• What role for public engagement?
• Patient Centered Outcomes Research Institute (PCORI): how can it help maximize CER benefits?
Objectives
• With CER push: (how) will public and private payers consider value in benefit design? g
• Implementation mechanisms: what’s feasible and fair?
• Within vs across disease prioritizations: potential?
• What role for public engagement?
• Patient Centered Outcomes Research Institute (PCORI): how can it help maximize CER benefits?
Two examples
Prostate cancer management, Plavix/Effient trial: Policy spectrum:Policy spectrum: • Provide all options – physician/patient judgment• Differential copays /Value Based Insurance Design (VBID)p y g ( )• Other steering (information, counseling…) • Deny coverage/access• Other -> Consensus: no ban, but shared decision making and use of
info Over time move down the ladder (3 5 Y)info. Over time, move down the ladder (3-5 Y)
Copays and VBID/’top-up’ payments
Pro: • “employers need it simple” branded/generic concept clear and y g
accepted, signaling effectCon: • blunt & potentially unfair (Newhouse/RAND)• blunt & potentially unfair (Newhouse/RAND),• operationalizability: “just good for low hanging fruit”? Key: • robustness of evidence, admin cost, feasibility (co-pays used
or not… payers vs payer/provider systems)• Fairness within group (Plavix): don’t penalize victims of• Fairness within group (Plavix): don t penalize victims of
genetic lottery • Fairness across groups: Who and why? (diabetics….)• Instead of drugs: focus on choice of providers, wellness