The Health Care Comparative Effectiveness Tool Kit

Promoting Value for Employee Health
 

Labor, Immigration & Employee Benefits Division
U.S. Chamber of Commerce
January 2009

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Executive Summary

The U.S. Chamber of Commerce (the Chamber) is dedicated to helping employers with employee health care management. Among other activities, the Chamber has championed the Leading by Example CEO Roundtable Initiative and the U.S. Workplace Wellness Alliance, both of which position employee health as a vital component of organizational success. The Chamber is providing this Health Care Comparative Effectiveness Tool Kit (the tool kit) to outline the trend toward use of comparative effectiveness information and patient engagement in order to improve employee health management.

Health information technology is assisting medical professionals and patients by making it easier to assess the effectiveness of treatment options from the real world health care experiences of Americans. Such work is sometime called comparative effectiveness analysis. Comparative effectiveness would address many types of medical interventions or products including drugs, medical devices, diagnostics, surgical procedures, and other therapies. This is done in a way that looks across the health care population and protects patient privacy. The information can help provide a profile of health care options, provide employees a better understanding of their options, and often provide information to assist them in managing their own health. Comparative effectiveness analysis sometimes shows that more expensive alternatives do not necessarily produce better outcomes.

Employers have an important stake in improving employee health management and greater understanding of comparative effectiveness information. This stake includes better employee health, greater productivity, and lower health insurance costs.

Comparative effectiveness information is only helpful if it is integrated into broader strategies of patient engagement, health care literacy, and employee health care support. Employer programs and initiatives vary greatly and may include health care coverage, wellness programs, and health clinics. More and more, employers are part of a circle of care for providing health information. For now, there are at least three things the Chamber recommends: (1) where relevant, engage patients and provide the Agency for Healthcare Research and Quality (AHRQ) effectiveness summaries, (2) encourage providers associated with your health plans to fully consider publicly available, evidence-based practice guidelines which are described below, and (3) begin to consider other ways to incorporate this growing base of information to improve coverage and employee health management.

Among other items, the tool kit refers to summaries by the AHRQ which provides basic information about certain medical conditions, findings about the effectiveness of various types of therapies from analysis of real world experiences of patients, and information about the long-term costs and other features of therapies for such medical conditions. Many of these summaries are about chronic medical conditions—important areas for patient engagement and significant areas of health care costs.

AHRQ's Effective Health Care (EHC) Program pursues a comparative effectiveness research agenda. The EHC Program includes a network of Evidence Based Practice Centers and the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network. The Evidence Based Practice Centers and DEcIDE Centers are university affiliated and private sector research organizations. Under the (EHC) Program, AHRQ surveys existing comparative effectiveness research in a priority area and identifies any gaps in the research. AHRQ then uses its research network to perform research in order to fill in these research gaps. After the research is performed, AHRQ's John M. Eisenberg Center makes the research publically available in an easily understandable format. The goal of the Effective Health Care Program is to improve the quality of medical care by increasing transparency about and access to medical information so patients and doctors can make informed decisions leading to better care.

While AHRQ is the primary Federal entity sponsoring comparative effectiveness research, the National Institutes of Health and the Department of Veterans Affairs also produce some comparative effectiveness information. Private sector entities, including pharmaceutical and durable medical equipment companies, pharmaceutical benefit managers, health plans, large provider groups, and private consulting firms also produce comparative clinical and costeffectiveness data.

These efforts are at the leading edge of a growing trend in generating and using comparative effectiveness information. In both Houses of Congress there is legislation which would establish and provide funds for an institute or similar entity to do more comparative effectiveness work. The growing pressure on costs and increasing demands for evidence to support given medical interventions are driving more study and greater political, policy, and practical acceptance of such work. In addition to generating knowledge about what works and how interventions compare, more effort is needed to translate this knowledge into common practice at a faster pace. The U.S. Chamber of Commerce encourages employers to maintain their leadership role in promoting quality and value in health care. Integrating current resources on comparative effectiveness to assist and engage employees and providers can be part of that leadership.

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