1. Medicaid and the Effective Health Care Program William Lawrence, MD, MS Center for Outcomes and Evidence

2. Effective Health Care Program To improve the quality, effectiveness, and efficiency of health care delivered through Medicare, Medicaid, and S-CHIP programs To improve the quality, effectiveness, and efficiency of health care delivered through Medicare, Medicaid, and S-CHIP programs – Focus is on what is known now: ensuring programs benefit from past investments in research and what research gaps are critical to fill – Focus is on clinical effectiveness

3. Program Infrastructure Review / compare existing evidence (Evidence Practice Centers) Accelerate practical studies (DEcIDE, CERTs) Translate evidence into improvements (Eisenberg Clinical Decisions & Communications Science Center)

4. Comparative Effectiveness Reviews (CERs) Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer - 2/5/2008 Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer - 2/5/2008 Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis – 12/17/2007 Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis – 12/17/2007 Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes – 7/17/2007 Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes – 7/17/2007 Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression - 1/24/2007 Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression - 1/24/2007 Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics - 1/17/2007 Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics - 1/17/2007 Comparative Effectiveness of Management Strategies for Renal Artery Stenosis - 10/24/2006 Comparative Effectiveness of Management Strategies for Renal Artery Stenosis - 10/24/2006

5. Comparative Effectiveness Reviews Concise Executive Summary Concise Executive Summary Full Report Full Report Available on-line in HTML and PDF Formats Available on-line in HTML and PDF Formats Effectivehealthcare.ahrq.gov

6. Translation Facilitate Informed Transparent Health Care Decisions by:  Patients  Providers  Policymakers Eisenberg Clinical Decisions and Communication Science Center Scientific Evidence Understandable and Usable Information

7. MMDLN Learning collaborative of state Medicaid Medical Directors – AHRQ acts as convener Learning collaborative of state Medicaid Medical Directors – AHRQ acts as convener 1 st F2F meeting 11/05 – 21 states represented 1 st F2F meeting 11/05 – 21 states represented In person workshops, topic oriented conference calls, web-based discussion forum for common issues In person workshops, topic oriented conference calls, web-based discussion forum for common issues Now 39 states involved, Steering Committee Elected Now 39 states involved, Steering Committee Elected Key focus on using evidence to support policy Key focus on using evidence to support policy

8. Working with the MMDLN What are the most salient topics to study? What are the most salient topics to study? – Long-term more than short-term When can evidence inform a decision? When can evidence inform a decision? Ongoing educational relationships – on both sides Ongoing educational relationships – on both sides – Informed researchers – Informed consumers

9. Improving Evidence Reports A core issue in usability of EPC reports – “Partner does not know how to conceptualize and articulate needs, objectives, and specifications of the [statement of work]” A core issue in usability of EPC reports – “Partner does not know how to conceptualize and articulate needs, objectives, and specifications of the [statement of work]” Suggested solution – “Establish an ongoing relationship between partners, EPC, and AHRQ early in the process” Suggested solution – “Establish an ongoing relationship between partners, EPC, and AHRQ early in the process” Matchar DB et. al. Developing a Methodology for Establishing A Statement of Work For a Policy-Relevant Technical Analysis. January, 2006

10. Examples Stakeholder Panel Stakeholder Panel Priority Conditions List Priority Conditions List Topic Development Topic Development Translation Products Translation Products

11. Stroke, including control of hypertension Pneumonia Peptic ulcer/dyspepsia Ischemic heart disease Diabetes mellitus Depression and other mood disorders Dementia, including Alzheimer’s disease Chronic obstructive pulmonary disease/asthma Cancer Arthritis and non-traumatic joint disorders Important Conditions Affecting Medicare Beneficiaries FY 04-07 - develop state-of-the-art information about effectiveness of interventions, including prescription drugs: FY 04-07 - develop state-of-the-art information about effectiveness of interventions, including prescription drugs:

12. Priority Conditions – Updated List Arthritis and non-traumatic joint disorders Arthritis and non-traumatic joint disorders Cancer Cancer Cardiovascular disease, including stroke and hypertension Cardiovascular disease, including stroke and hypertension Dementia, including Alzheimer Disease Dementia, including Alzheimer Disease Depression and other mental health disorders Depression and other mental health disorders Developmental delays, attention-deficit hyperactivity disorder and autism Developmental delays, attention-deficit hyperactivity disorder and autism Diabetes Mellitus Diabetes Mellitus Functional limitations and disability Functional limitations and disability Infectious diseases including HIV/AIDS Infectious diseases including HIV/AIDS Obesity Obesity Peptic ulcer disease and dyspepsia Peptic ulcer disease and dyspepsia Pregnancy including pre-term birth Pregnancy including pre-term birth Pulmonary disease/Asthma Pulmonary disease/Asthma Substance abuse Substance abuse

13. Topic Development Process

14. Eisenberg Center Publications Clinician Guides Policy Maker Guides Consumer Guides

15. effectivehealthcare.ahrq.gov