Encourage Research on What Works - What the Government Should Do

BCBSA recommends the government take the following actions to encourage research on what works best and put it into practice:

Create a New Comparative Effectiveness Research Institute

The Institute Should Support a Broad Range of Research, Including Clinical Trials

The Institute should prioritize and fund a variety of research – including clinical trials, cohort studies, literature reviews and other studies – evaluating the comparative clinical and cost effectiveness of different procedures, drugs, devices and biologics. The Institute may contract with existing entities (e.g., the Agency for Healthcare Research and Quality (AHRQ)) to facilitate research. The Institute also should encourage improved efficiency by collaborating with the institutions that receive comparative research contracts to identify best practices and efficiencies in order to maximize research dollars.

The Institute should be structured as an independent, federally chartered, not-for-profit entity so that political pressures are not a factor in the Institute's decision-making, establishing priorities or releasing results. The Institute should be governed by a board of experts that reflects the perspectives of a wide range of stakeholders (e.g., providers, consumers, government, health insurers, employers and manufacturers).

The most significant challenge in creating the new Institute will be ensuring a stable and significant funding source. BCBSA believes that the Institute should be funded by assessments on all private coverage (insured and self-funded) and public healthcare coverage such as Medicare, Medicaid and other government programs. BCBSA recommends a budget not to exceed $375 million annually.

Significant Education and Incentives Are Needed to Ensure New Research that Improves Clinical Practice

The Institute should ensure that new comparative information is disseminated to providers, patients and others. Because experts estimate that medical research currently takes 17 years to be incorporated into practice, it is especially important that this information be provided in formats providers easily can use (Balas and Boren, 2000). The Institute should work with medical societies to develop consensus practice guidelines drawing on the Institute's research. Electronic medical records should be required to incorporate these guidelines into their clinical decision support systems. Medicare and other public programs should be required to consider the Institute's research in developing pay-for-performance, coverage, reimbursement and other policies.

In addition, the guidelines' evidence-based standards should create rebuttable presumptions concerning the standards of care that providers are expected to meet in medical malpractice cases. Providers that reasonably rely on the guidelines should be given safe harbors for noneconomic (e.g., pain and suffering) and punitive damages. Similar protections should apply to insurers in adjudicating claims.