Leveraging Comparative Effectiveness Research & Public Purchasers: What’s Next? For PUBLIC SECTOR HEALTHCARE ROUNDTABLE NOVEMBER 2, 2017 Anand Parekh, M.D., M.P.H. chief medical advisor Bipartisan Policy Center

Key points Comparative Effectiveness Research (CER) can be extraordinarily helpful for patients, providers, & payers. We have yet to realize the full promise of CER with respect to optimal care delivery. Dissemination & translation will be key. CER will continue to be increasingly important in the future as newer services & technologies come to fruition. Patient-Centered Outcomes Research Institute (PCORI) has been very active since 2010. The next few years will be critical for it to bring results to bear and tell its story. It is not yet clear to what extent the current Administration will accelerate federal comparative effectiveness research efforts across HHS & VA. In this era of Big Data, the private sector, particularly purchasers and insurers, have an opportunity to invest in CER.

CER DEFINITION “CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.” Institute of Medicine, 2009

2009: The Recovery Act infused $1.1 billion into CER. Cer background Several federal departments (e.g., VA) and agencies (e.g., AHRQ) have been conducting CER for decades. 2009: The Recovery Act infused $1.1 billion into CER. 2009: The Institute of Medicine identified a priority list for research questions to be addressed by CER. 2009-10: There was significant debate pre-Affordable Care Act (ACA) on the creation of PCORI. 2010: PCORI was created through the ACA. Funded through the PCOR Trust Fund which receives funding from 3 funding streams: Appropriations from the general fund of the Treasury ($120M in FY15) Transfers from the Centers for Medicare & Medicaid Services Trust Fund ($90M in FY15) A $2.26 per covered person per year fee assessed on private insurance and self-insured health plans ($210M in FY15) 2019: PCORI will be up for reauthorization.

Research on CER infrastructure/methodology Key PCORI invesTMENTS Research on CER infrastructure/methodology PCORnet Research on comparing medical interventions Pragmatic Clinical Studies Economic Modeling Research on communication tools & education initiatives Patient Decision Aids

Bpc forum exploring patient-centered cer June 2017

Private Payers/Purchasers Pharmaceutical/Medical Device Sector Additional OPPORTUNITIES to advance cer Federal Agencies NIH AHRQ March 2015 GAO Report focused on Dissemination efforts Private Payers/Purchasers Pharmaceutical/Medical Device Sector