CMS as a Public Health Agency: Effective Health Care Research Barry M. Straube, M.D. Centers for Medicare & Medicaid Services January 11, 2006

Centers for Medicare & Medicaid Services (CMS) CMS as a Public Health Agency CMS as a Public Health Agency Using CMS influence and financial leverage to transform American healthcare system Using CMS influence and financial leverage to transform American healthcare system Focusing on not just Medicare & Medicaid, but also Commercial, uninsured, etc. Focusing on not just Medicare & Medicaid, but also Commercial, uninsured, etc. Quality, Value, Efficiency, Cost-effectiveness Quality, Value, Efficiency, Cost-effectiveness Assisting patients and providers in receiving evidence- based, technologically-advanced care while reducing avoidable complications & unnecessary costs Assisting patients and providers in receiving evidence- based, technologically-advanced care while reducing avoidable complications & unnecessary costs

Table 3.6 Number of Medicare Beneficiaries, * Numbers may not sum due to rounding. Source: CMS, Office of the Actuary. The number of people Medicare serves will nearly double by * * * 76.8 Medicare Enrollment (millions)

A Variation Problem Dartmouth Atlas of Healthcare

CMS Quality Roadmap VISION: The right care for every person every time VISION: The right care for every person every time Make care: Make care: Safe Safe Effective Effective Efficient Efficient Patient-centered Patient-centered Timely Timely Equitable Equitable

CMS Quality Roadmap: Strategies 1. Work through partnerships to achieve specific quality goals 2. Publish quality measurements and information as a basis for supporting more effective quality improvement efforts 3. Pay in a way that expresses our commitment to quality, and that helps providers and patients to take steps to improve health and avoid unnecessary costs

CMS Quality Roadmap: Strategies for QI 4. Assist practitioners in making care more effective and less costly, especially by promoting the adoption of HIT 5. Bring effective new treatments to patients more rapidly and help develop better evidence so that doctors and patients can use medical technologies and treatments more effectively, improve quality and avoid unnecessary complications and costs

MMA Section 1013 Authorizes AHRQ to conduct and support research with a focus on clinical outcomes, comparative clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services Authorizes AHRQ to conduct and support research with a focus on clinical outcomes, comparative clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services Research informed by needs of Medicare, Medicaid and State Children’s Health Insurance (SCHIP) programs Research informed by needs of Medicare, Medicaid and State Children’s Health Insurance (SCHIP) programs

CMS Partnership with AHRQ Jointly selected 10 conditions affecting Medicare beneficiaries, with AHRQ to analyze effectiveness of interventions: Jointly selected 10 conditions affecting Medicare beneficiaries, with AHRQ to analyze effectiveness of interventions: Ischemic heart disease Ischemic heart disease Cancer Cancer Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease Stroke, including control of hypertension Stroke, including control of hypertension Arthritis and non-traumatic joint disorders Arthritis and non-traumatic joint disorders Diabetes mellitus Diabetes mellitus Dementia, including Alzheimer’s disease Dementia, including Alzheimer’s disease Pneumonia Pneumonia Peptic ulcer disease/dyspepsia Peptic ulcer disease/dyspepsia Depression and other mood disorders Depression and other mood disorders

CMS Partnership with AHRQ CMS represented on the review committee of proposals for the DEcIDE research centers CMS represented on the review committee of proposals for the DEcIDE research centers CMS also supporting the registry project which will address topics of: CMS also supporting the registry project which will address topics of: Registry creation Registry creation Registry operations Registry operations Evaluation of registry design and operations Evaluation of registry design and operations Dr. Clancy will review other aspects of the Effective Health Care program Dr. Clancy will review other aspects of the Effective Health Care program

Why We Need Comparative Effectiveness Reviews Sound foundation of evidence about which treatments work best is essential to help doctors and patients achieve the best quality care Sound foundation of evidence about which treatments work best is essential to help doctors and patients achieve the best quality care We need to have such evidence available in useful and understandable formats We need to have such evidence available in useful and understandable formats AHRQ’s issuance of CERs are an important milestone to achieving these goals AHRQ’s issuance of CERs are an important milestone to achieving these goals Beneficiaries in Medicare & Medicaid and their doctors will have better information about costs and benefits of treatment for a common health problem with multiple treatment options available Beneficiaries in Medicare & Medicaid and their doctors will have better information about costs and benefits of treatment for a common health problem with multiple treatment options available

Why We Need Comparative Effectiveness Reviews Better evidence on what works is a centerpiece of the prescription drug benefit and other reforms being implemented by CMS right now to bring the Medicare program up to date Better evidence on what works is a centerpiece of the prescription drug benefit and other reforms being implemented by CMS right now to bring the Medicare program up to date We need to do more to learn about and measure the effectiveness of alternative treatments for common health problems We need to do more to learn about and measure the effectiveness of alternative treatments for common health problems We need to do more to help patients and doctors get unbiased, practically useful information on benefits, risks, and costs We need to do more to help patients and doctors get unbiased, practically useful information on benefits, risks, and costs

CMS Focus on Evidence Development and Use National and Local Coverage Decisions National and Local Coverage Decisions Coverage with Evidence Development (CED) Coverage with Evidence Development (CED) Quality measures and benchmarks Quality measures and benchmarks Quality improvement initiatives Quality improvement initiatives Pay-for-Performance (P4P) programs Pay-for-Performance (P4P) programs Adoption of new medical technologies and innovations Adoption of new medical technologies and innovations Medicare Compare Websites Medicare Compare Websites Clinical guidelines Clinical guidelines Prescription drug program Prescription drug program Medicare Advantage program Medicare Advantage program Health Information Technology, ePrescribing, etc. Health Information Technology, ePrescribing, etc.

Summary Use of better evidence in clinical care and health policy decision-making will: Use of better evidence in clinical care and health policy decision-making will: Improve the quality of care Improve the quality of care Improve health outcomes and well-being Improve health outcomes and well-being Achieve better value for health care dollars spent Achieve better value for health care dollars spent Promote better health care partnerships between patients and their doctors, nurses, and other clinicians Promote better health care partnerships between patients and their doctors, nurses, and other clinicians CMS looks forward to today’s session and identifying new topics for effectiveness reviews CMS looks forward to today’s session and identifying new topics for effectiveness reviews

Contact Information Barry M. Straube, M.D. Acting Chief Medical Officer Acting Director, Office of Clinical Standards & Quality Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD Phone: (410)