Scott Serota Remarks, National Press Announcement, Institute for Comparative Effectiveness Research, National Press Club, Washington, D.C., May 7, 2007

May 10, 2007

Welcome – I am pleased you are here.

Joining me today are:

• Dr. John Fallon, Chief Physician Executive at Blue Cross and Blue Shield of Massachusetts, and
• Debra Ness, president of the National Partnership for Women and Families, based here in DC

You will be hearing from them a bit later.

The Blue Cross and Blue Shield Association and our 39 Blue Cross and Blue Shield companies serving more than 98 million people – one-in-three Americans – strongly believe fact-based decisions are the key to transforming healthcare in our country.

As we have for more than 77 years, the Blues are committed to improving the quality, safety and affordability of our nation's healthcare system. 

Over the past year, we have been focusing much of our attention on the uninsured … and one outcome of our work is the realization that the root cause of the uninsured challenge facing us is a lack of value and quality assurance in our system.

In the coming months, the Blues will be launching a multi-pronged strategy to improve value and quality in our healthcare system – as well as overall affordability and the uninsured – and today marks the first step in this process.

Across our country today, far too much of the care delivered in hospitals, clinics, outpatient centers and other settings is simply not evidence-based care.

• One study estimates as much as 30 percent of the overall care delivered is ineffective, inappropriate or redundant
• Another study found that only slightly more than half of acute care (54 percent) and chronic care (56 percent) provided by physicians conforms to medical literature

We can and must help providers deliver better and more consistent clinical care to their patients.  Delivering better, safer and more consistent care also will help us as a nation make more effective use of our limited healthcare resources.

We believe an important next step should be the creation of an independent institute devoted exclusively to developing credible clinical information on the comparative effectiveness of new and existing medical procedures, drugs, devices and biologics.

We call on Congress to pass a bill to create such an independent institute … and we pledge to do all we can to help the legislation become law – including doing our fair share to help fund the new institute and to support it.

What do I mean by our fair share?

Estimates are it will cost about $500 million to fund the Institute in its first year.  While that is a substantial amount – $500 million represents only a fraction of the nation's more than $2 trillion in annual health expenditures – and the Blues are prepared to fund our fair share of the total.

Frankly, we view it as a great investment in consumer health and a better healthcare system for the future.

We strongly believe funding for the institute must come from all payers – including government programs such as Medicare and Medicaid – as well as insurers and self-funded plans.

Independence and objectivity will best be achieved by a broad-based funding source for the institute.  

We think the new institute should be developed based on several core principles:

First … the Institute should be an independent entity.

• It should be non-profit, and governed by a board of experts representing diverse interests
• That should include:  Public and private payers, providers, consumers and key industry stakeholders
• The institute should be protected from outside pressures – including political interests – so it can truly be a credible source for evidence-based information

Second … the institute should support a broad range of research to evaluate the clinical – and cost-effectiveness – of different procedures, drugs, devices and biologics.

• This would include clinical trials, cohort studies, literature reviews and other scientific investigation
• The institute will fill a very important role in this regard because currently no organization has this degree of focus on comparative clinical research
• This is especially true for clinical trials – and the great costs of clinical trials
• Clinical trials can cost millions of dollars – making it unlikely other entities have resources to adequately sponsor them
• We think it is also important that the institute maximize available research dollars by encouraging efficiencies across all of healthcare and collaborating with other institutions that receive comparative research contracts

Third … it should focus on education and incentives.

• Experts estimate that – under our current system – medical research takes up to 17 years to be incorporated into healthcare practice
• The institute should work with medical societies to develop consensus practice guidelines
• Electronic health records should be required to incorporate agreed-upon guidelines into provider clinical decision support systems
• The institute must ensure that new comparative information is disseminated promptly and widely to providers, consumers and others in formats that providers can easily use
• Finally … Medicare and other public programs should be required to consider the institute's research in developing pay-for-performance, coverage, reimbursement and other key policies

We also propose a significant change in the malpractice arena.  Providers that follow agreed-upon guidelines developed by the institute should be given safe-harbor for non-economic (pain and suffering) and punitive damages.

In this regard, creation of the institute can go a long way toward badly needed tort reform and help rid us and our overworked court system of numerous frivolous lawsuits that benefit trial lawyers far more than their consumer clients.

We in the Blues also pledge our support for the new institute by sharing what we have learned from more than 20 years of industry-leading work by our Technology Evaluation Center. 

As many of you know, TEC pioneered the development of scientific criteria for assessing medical technologies based on comprehensive reviews of clinical evidence.  Today, it is one of only 13 evidence-based practice centers across the country selected by the Agency for healthcare Research and Quality and there is much TEC can share with the new institute.

In closing, I want to say I think the time is right for the creation of the institute.  I believe it can be a major step forward for all of us in the healthcare arena.  We view it as a critical platform to foster collaboration between providers, insurers and employers to assure that the best and most effective treatments are available – and that will improve the affordability of care.

I believe consumers will see the value and be supportive – because the institute will help improve the quality of care in our country and help keep healthcare affordable for them and their families.

And finally, we call on Congress to pass legislation creating the institute with broad-based funding from all payers – both public and private.

We in the Blues are ready to do our part.