Medicaid and the Effective Medicaid and the Effective Health Care Program Health Care Program William Lawrence, MD, MS William Lawrence, MD, MS Center for Outcomes and Evidence Center for Outcomes and Evidence
Dec 13, 2015
Medicaid and the Effective Health Medicaid and the Effective Health Care ProgramCare Program
William Lawrence, MD, MSWilliam Lawrence, MD, MSCenter for Outcomes and EvidenceCenter for Outcomes and Evidence
Effective Health Care Effective Health Care ProgramProgram
To improve the quality, effectiveness, To improve the quality, effectiveness, and efficiency of health care and efficiency of health care delivered through Medicare, delivered through Medicare, Medicaid, and S-CHIP programsMedicaid, and S-CHIP programs– Focus is on what is known Focus is on what is known nownow: ensuring : ensuring
programs benefit from programs benefit from pastpast investments in investments in research and what research research and what research gapsgaps are are critical to fillcritical to fill
– Focus is on Focus is on clinical effectivenessclinical effectiveness
Program InfrastructureProgram Infrastructure
Review / compare Review / compare existing evidence existing evidence
(Evidence Practice Centers)(Evidence Practice Centers)
Accelerate Accelerate practical studies practical studies
(DEcIDE, CERTs)(DEcIDE, CERTs)
Translate evidence into improvements Translate evidence into improvements (Eisenberg Clinical Decisions & (Eisenberg Clinical Decisions &
Communications Science Center)Communications Science Center)
Comparative Effectiveness Comparative Effectiveness Reviews (CERs)Reviews (CERs)
Comparative Effectiveness of Therapies for Clinically Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer - 2/5/2008Localized Prostate Cancer - 2/5/2008
Comparative Effectiveness of Treatments to Prevent Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density Fractures in Men and Women with Low Bone Density or Osteoporosis – 12/17/2007or Osteoporosis – 12/17/2007
Comparative Effectiveness and Safety of Oral Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes Diabetes Medications for Adults With Type 2 Diabetes – 7/17/2007– 7/17/2007
Comparative Effectiveness of Second-Generation Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Antidepressants in the Pharmacologic Treatment of Adult Depression - 1/24/2007Adult Depression - 1/24/2007
Efficacy and Comparative Effectiveness of Off-Label Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics - 1/17/2007Use of Atypical Antipsychotics - 1/17/2007
Comparative Effectiveness of Management Strategies Comparative Effectiveness of Management Strategies for Renal Artery Stenosis - 10/24/2006 for Renal Artery Stenosis - 10/24/2006
Comparative Effectiveness Comparative Effectiveness ReviewsReviews
Concise Executive Concise Executive SummarySummary
Full ReportFull Report
Available on-line in Available on-line in HTML and PDF HTML and PDF FormatsFormats
Effectivehealthcare.ahrq.gov
Translation
Facilitate Informed Transparent Health Care Decisions by: Patients Providers Policymakers
Eisenberg Clinical Decisions and Eisenberg Clinical Decisions and Communication Science CenterCommunication Science Center
ScientificEvidence
Understandableand UsableInformation
MMDLNMMDLN
Learning collaborative of state Medicaid Learning collaborative of state Medicaid Medical Directors – AHRQ acts as convenerMedical Directors – AHRQ acts as convener
11stst F2F meeting 11/05 – 21 states represented F2F meeting 11/05 – 21 states represented In person workshops, topic oriented In person workshops, topic oriented
conference calls, web-based discussion forum conference calls, web-based discussion forum for common issuesfor common issues
Now 39 states involved, Steering Committee Now 39 states involved, Steering Committee ElectedElected
Key focus on using evidence to support policyKey focus on using evidence to support policy
Working with the MMDLNWorking with the MMDLN
What are the most salient topics to What are the most salient topics to study?study?– Long-term more than short-termLong-term more than short-term
When can evidence inform a decision?When can evidence inform a decision? Ongoing educational relationships – on Ongoing educational relationships – on
both sidesboth sides– Informed researchersInformed researchers
– Informed consumersInformed consumers
Improving Evidence ReportsImproving Evidence Reports
A core issue in usability of EPC reports – A core issue in usability of EPC reports – “Partner does not know how to conceptualize “Partner does not know how to conceptualize and articulate needs, objectives, and and articulate needs, objectives, and specifications of the [statement of work]”specifications of the [statement of work]”
Suggested solution – “Establish an ongoing Suggested solution – “Establish an ongoing relationship between partners, EPC, and relationship between partners, EPC, and AHRQ early in the process”AHRQ early in the process”
Matchar DB et. al. Developing a Methodology for EstablishingA Statement of Work For a Policy-Relevant Technical Analysis. January, 2006
ExamplesExamples
Stakeholder PanelStakeholder Panel Priority Conditions ListPriority Conditions List Topic DevelopmentTopic Development Translation ProductsTranslation Products
Stroke, including control of hypertensionPneumoniaPeptic ulcer/dyspepsiaIschemic heart diseaseDiabetes mellitusDepression and other mood disordersDementia, including Alzheimer’s diseaseChronic obstructive pulmonary disease/asthmaCancerArthritis and non-traumatic joint disorders
Important Conditions Affecting Important Conditions Affecting Medicare BeneficiariesMedicare Beneficiaries
FY 04-07 - develop state-of-the-art FY 04-07 - develop state-of-the-art information about effectiveness of information about effectiveness of interventions, including prescription drugs:interventions, including prescription drugs:
Priority Conditions – Updated Priority Conditions – Updated ListList
Arthritis and non-traumatic joint disordersArthritis and non-traumatic joint disorders CancerCancer Cardiovascular disease, including stroke and hypertensionCardiovascular disease, including stroke and hypertension Dementia, including Alzheimer DiseaseDementia, including Alzheimer Disease Depression and other mental health disordersDepression and other mental health disorders Developmental delays, attention-deficit hyperactivity disorder and Developmental delays, attention-deficit hyperactivity disorder and
autismautism Diabetes MellitusDiabetes Mellitus Functional limitations and disabilityFunctional limitations and disability Infectious diseases including HIV/AIDSInfectious diseases including HIV/AIDS ObesityObesity Peptic ulcer disease and dyspepsiaPeptic ulcer disease and dyspepsia Pregnancy including pre-term birthPregnancy including pre-term birth Pulmonary disease/AsthmaPulmonary disease/Asthma Substance abuseSubstance abuse
Topic Development Topic Development ProcessProcess
Eisenberg Center PublicationsEisenberg Center Publications
Clinician Clinician GuidesGuides
Policy Maker Policy Maker GuidesGuides
Consumer Consumer GuidesGuides
effectivehealthcare.ahrq.goveffectivehealthcare.ahrq.gov