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Comparative Effectiveness Research? It’s About Time!

David P. Lind BenchmarkI’m all for it.

An earlier blog of mine described the dysfunctional health care delivery “system” that we have in this country. The intent of my blogs is not to point fingers, as assessment of blame does little to solve the problems we have within our own state and country.

A recent California study was published about the associated cost to remove an appendix. As typical, the cost for this procedure could be as little as the price for a refrigerator – or a house! The cost disparities were alarming, ranging from $1,500 (refrigerator) to $180,000 (house). How can this happen?  Why is this allowed? Are the outcomes of the procedures better at a higher price?

Don’t know. That’s part of our problem.

That is why I see a glimmer of hope for a new initiative (generated by the health reform law) called, Comparative Effectiveness Research (CER). In a nutshell, CER includes research to evaluate risks and benefits of medical treatments, services, procedures, and drugs that treat, manage, diagnose or prevent illness or injury. Too often we have extreme variations on how procedures are performed, both by region and by health providers. CER will attempt to help bridge this gap of extreme variation using sound research when comparing health outcomes. Reducing variation chasms can save lives AND potentially big bucks.

Don’t take my word on this subject. The  Dartmouth Atlas of Health Care does a good job of documenting the variations of health care that is delivered in this country.

CER will be funded through a fee that will be assessed to plan sponsors and issuers of individual and group policies. Plan sponsors will be required to pay $1 per member per year beginning with policy or plan years ending after September 30, 2012. The fee increases to $2 per member annually for policy years ending after September 30, 2013. The fee will discontinue after September 30, 2019. See the published Federal Register on this fee.

I admit, paying additional fees within your insurance premium does not sound good – especially when premiums have increased by over 141 percent during the last 13 years in Iowa* (about the same nationally). But perhaps CER will more than pay for itself by providing a sound practice of comparing the risks and benefits of two or more medical treatments based on health outcomes and clinical effectiveness.

We can only hope.

*2011 Iowa Employer Benefits Study©

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