Comparative effectiveness is a relatively new concept in the United States, so the Deloitte Center for Health Solutions examined how well it works in the United Kingdom, Australia, Canada, and Germany. Comparative effectiveness compares two or more treatments for a given condition. Studies may compare similar treatments, such as two drugs, or very different approaches, such as surgery and drug therapy.

Deloitte looked at diagnostic screening detection for colon cancer, the use of statins for the treatment of elevated cholesterol, and surgery for benign prostatic hyperplasia. The findings suggest that if implemented correctly, comparative effectiveness has the potential to improve care and reduce health care costs for Americans.

“Comparative effectiveness can be seen as an engine for renewed innovation in the design and delivery of evidence-based care,” says Paul H. Keckley, PhD, executive director.

The report points out that although the annual cost of health care in the United States is $2 trillion, less than 1 percent is invested in assessing the comparative effectiveness of available interventions. According to the report, although the American Recovery and Reconstruction Act of 2009 allocated $1.1 billion to comparative effectiveness research, “The cost of building national programs and establishing a comparative effectiveness framework; support for clinical trials, syntheses and analytics; and the development of education strategies will challenge this initial investment.”

In Britain and Australia, the comparative effectiveness data actually determine national health benefits. In Germany and Canada, the link is less overt.

“For comparative effectiveness to work in the United States, it will require cooperation between all stakeholders, from life sciences companies to payers, providers, policymakers, and consumers, to achieve maximum benefit,” says Terry Hisey, a vice chairman of Deloitte.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.