Comparative effectiveness research is designed to provide information to assist providers, patients, payers and policymakers in determining what diagnostic tools and treatments work best, and how the health care system may best be organized and care delivered to maximize outcomes. While it is not the same as cost-effectiveness research, which attempts to quantify how much value is being delivered by alternative treatments or delivery methods, ideally the two would be incorporated into the same research. One of the many shortcomings of the reform law is that it forbade the use of comparative effectiveness research funded by the law for purposes of reimbursement or coverage determinations. This means that there is little effective way for payers to create incentives for patients or providers to be steered toward what research shows is likely to work best. Nonetheless, comparative effectiveness steams ahead, with the Patient Centered Outcomes Research Institute putting out its initial foray into priorities for public comment. (PCORI Draft)
The draft identifies five areas: comparisons of prevention, diagnosis and treatment options; improving health care systems; communication and dissemination of results; addressing disparities and accelerating patient-centered and methodological research. A general path is sketched whereby priorities are set, a specific agenda for research is created, the research is funded, creates results and then is used to adjust priorities for the next round. The criteria to be used to go from priorities to agenda include the impact of specific proposed research on the health of individuals and populations; the likelihood of improvability through research; inclusiveness of different subpopulations; addressing current knowledge gaps and current variation in care; the effect on health system performance; the potential to influence decision-making; patient-centeredness; rigorous research method use and efficiency in using limited research dollars.
While there are a lot of buzz words, this actually is very important research and should be focused largely on real-world big dollar areas of care where there is uncertainty about value; and payers should be required to make coverage and reimbursement decisions on the basis of the research results and should incent patients and providers to use the findings to guide care decisions. While there is always uncertainty about the best course of treatment for an individual patient, and some flexibility needs to exist, there is already plenty of evidence that often providers do what is financially best for them, not what offers the best outcomes at the lowest price for the patient.