Medicaid and the Effective Health Medicaid and the Effective Health Care ProgramCare Program

William Lawrence, MD, MSWilliam Lawrence, MD, MSCenter for Outcomes and EvidenceCenter for Outcomes and Evidence

Effective Health Care Effective Health Care ProgramProgram

To improve the quality, effectiveness, To improve the quality, effectiveness, and efficiency of health care and efficiency of health care delivered through Medicare, delivered through Medicare, Medicaid, and S-CHIP programsMedicaid, and S-CHIP programs– Focus is on what is known Focus is on what is known nownow: ensuring : ensuring

programs benefit from programs benefit from pastpast investments in investments in research and what research research and what research gapsgaps are are critical to fillcritical to fill

– Focus is on Focus is on clinical effectivenessclinical effectiveness

Program InfrastructureProgram Infrastructure

Review / compare Review / compare existing evidence existing evidence

(Evidence Practice Centers)(Evidence Practice Centers)

Accelerate Accelerate practical studies practical studies

(DEcIDE, CERTs)(DEcIDE, CERTs)

Translate evidence into improvements Translate evidence into improvements (Eisenberg Clinical Decisions & (Eisenberg Clinical Decisions &

Communications Science Center)Communications Science Center)

Comparative Effectiveness Comparative Effectiveness Reviews (CERs)Reviews (CERs)

Comparative Effectiveness of Therapies for Clinically Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer - 2/5/2008Localized Prostate Cancer - 2/5/2008

Comparative Effectiveness of Treatments to Prevent Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density Fractures in Men and Women with Low Bone Density or Osteoporosis – 12/17/2007or Osteoporosis – 12/17/2007

Comparative Effectiveness and Safety of Oral Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes Diabetes Medications for Adults With Type 2 Diabetes – 7/17/2007– 7/17/2007

Comparative Effectiveness of Second-Generation Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Antidepressants in the Pharmacologic Treatment of Adult Depression - 1/24/2007Adult Depression - 1/24/2007

Efficacy and Comparative Effectiveness of Off-Label Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics - 1/17/2007Use of Atypical Antipsychotics - 1/17/2007

Comparative Effectiveness of Management Strategies Comparative Effectiveness of Management Strategies for Renal Artery Stenosis - 10/24/2006 for Renal Artery Stenosis - 10/24/2006

Comparative Effectiveness Comparative Effectiveness ReviewsReviews

Concise Executive Concise Executive SummarySummary

Full ReportFull Report

Available on-line in Available on-line in HTML and PDF HTML and PDF FormatsFormats

Effectivehealthcare.ahrq.gov

Translation

Facilitate Informed Transparent Health Care Decisions by: Patients Providers Policymakers

Eisenberg Clinical Decisions and Eisenberg Clinical Decisions and Communication Science CenterCommunication Science Center

ScientificEvidence

Understandableand UsableInformation

MMDLNMMDLN

Learning collaborative of state Medicaid Learning collaborative of state Medicaid Medical Directors – AHRQ acts as convenerMedical Directors – AHRQ acts as convener

11stst F2F meeting 11/05 – 21 states represented F2F meeting 11/05 – 21 states represented In person workshops, topic oriented In person workshops, topic oriented

conference calls, web-based discussion forum conference calls, web-based discussion forum for common issuesfor common issues

Now 39 states involved, Steering Committee Now 39 states involved, Steering Committee ElectedElected

Key focus on using evidence to support policyKey focus on using evidence to support policy

Working with the MMDLNWorking with the MMDLN

What are the most salient topics to What are the most salient topics to study?study?– Long-term more than short-termLong-term more than short-term

When can evidence inform a decision?When can evidence inform a decision? Ongoing educational relationships – on Ongoing educational relationships – on

both sidesboth sides– Informed researchersInformed researchers

– Informed consumersInformed consumers

Improving Evidence ReportsImproving Evidence Reports

A core issue in usability of EPC reports – A core issue in usability of EPC reports – “Partner does not know how to conceptualize “Partner does not know how to conceptualize and articulate needs, objectives, and and articulate needs, objectives, and specifications of the [statement of work]”specifications of the [statement of work]”

Suggested solution – “Establish an ongoing Suggested solution – “Establish an ongoing relationship between partners, EPC, and relationship between partners, EPC, and AHRQ early in the process”AHRQ early in the process”

Matchar DB et. al. Developing a Methodology for EstablishingA Statement of Work For a Policy-Relevant Technical Analysis. January, 2006

ExamplesExamples

Stakeholder PanelStakeholder Panel Priority Conditions ListPriority Conditions List Topic DevelopmentTopic Development Translation ProductsTranslation Products

Stroke, including control of hypertensionPneumoniaPeptic ulcer/dyspepsiaIschemic heart diseaseDiabetes mellitusDepression and other mood disordersDementia, including Alzheimer’s diseaseChronic obstructive pulmonary disease/asthmaCancerArthritis and non-traumatic joint disorders

Important Conditions Affecting Important Conditions Affecting Medicare BeneficiariesMedicare Beneficiaries

FY 04-07 - develop state-of-the-art FY 04-07 - develop state-of-the-art information about effectiveness of information about effectiveness of interventions, including prescription drugs:interventions, including prescription drugs:

Priority Conditions – Updated Priority Conditions – Updated ListList

Arthritis and non-traumatic joint disordersArthritis and non-traumatic joint disorders CancerCancer Cardiovascular disease, including stroke and hypertensionCardiovascular disease, including stroke and hypertension Dementia, including Alzheimer DiseaseDementia, including Alzheimer Disease Depression and other mental health disordersDepression and other mental health disorders Developmental delays, attention-deficit hyperactivity disorder and Developmental delays, attention-deficit hyperactivity disorder and

autismautism Diabetes MellitusDiabetes Mellitus Functional limitations and disabilityFunctional limitations and disability Infectious diseases including HIV/AIDSInfectious diseases including HIV/AIDS ObesityObesity Peptic ulcer disease and dyspepsiaPeptic ulcer disease and dyspepsia Pregnancy including pre-term birthPregnancy including pre-term birth Pulmonary disease/AsthmaPulmonary disease/Asthma Substance abuseSubstance abuse

Topic Development Topic Development ProcessProcess

Eisenberg Center PublicationsEisenberg Center Publications

Clinician Clinician GuidesGuides

Policy Maker Policy Maker GuidesGuides

Consumer Consumer GuidesGuides

effectivehealthcare.ahrq.goveffectivehealthcare.ahrq.gov