1. Using Evidence For Better Health Policy
Better Information * Better Health * Reduced Variation
Leah Hole-Curry, HCA

2. Problem: Low Access, Highest cost, Low Quality, Waste (2007 WA Blue Ribbon Comm.)
593,000 Washingtonians (inc. 73,000 children) without health care
The state spends $4.5 billion on health care, up from $2.7 billion in This is increase from 22% in 2000 to 28% in 2007
US spends more, but ranks lower on performance and health outcomes
20-30% of current health expenditures do not improve or extend life. (also recommended care received only 55% of time)
WA’s Answer: Gov and Legislature
use evidence based medicine to reduce waste, increase quality, and get better value (one of five point strategy)
Dartmouth/Wennberg’s Answer for WA - better outcome and lower cost
Reduce Overuse of Supply Sensitive Care – accounts for 63% of variation and waste, (one of three point approach)
Manage growth/capacity of new, high cost, unproven value technology (use of scientific research prior to approval)
Commonwealth’s Bending the Cost Curve (#1 answer)
Comparative Effectiveness Research - save $368 billion over 10 yrs by using relative clinical and cost-effectiveness treatment information
Why Evidence Based Policy ?
What are the program’s policy

3. Health Technology Assessment (HTA)
Pay for What Works: Better Information is Better health
Transparency
publish process, criteria, reports
committee decisions in open, public meeting
Evidence Reports
Formal, systematic process to identify, review, and cover appropriate health care technologies
Coverage decisions
Independent committee of health care providers
Rely primarily on evidence report
Consistent across state health care purchasing agencies
Is it safe?
Is it effective?
Does it provide value (improve health outcome)?
Why Evidence Based Policy ?
What are the program’s policy

4. New Health Purchasing Focus: Hierarchy of Evidence
Best: Meta-analysis of large randomized head-to-head trials.
Large, well-designed head-to head randomized controlled clinical trials (RCT):
Long-term studies, real clinical endpoints
Well accepted intermediates
Poorly accepted intermediates
Smaller RCTs, or separate, placebo-controlled trials
Well-designed observational studies, e.g., cohort studies, case-control studies
Safety data without efficacy studies
Case series, anecdotes
Least: Expert opinion, non-evidence-based expert panel reports, and other documents with no direct clinical evidence
Describe hierarchy of evidence.
Level 3: “What would I recommend to the state or nation?”
Must be based on rigorous assessment of the scientific evidence.
Affects hundreds of thousands, even millions of people.
Level 2: “What would I recommend to my patient/client?”
Influenced by prior experience, but the scientific evidence may play a greater role.
Affects possibly hundreds of people.
Level 1: “Would you have this done for yourself or for someone else in your immediate family?”
Influenced by one’s personal experience with the disease and capacity to deal with risk.
Affects few people.

5. HTA Program Elements Four Keys
HCA Administrator Selects Technology
Nominate, Review, Public Input, Prioritize
Vendor Produce Technology Assessment Report
Key Questions and Work Plan, Draft, Comments, Finalize
Clinical Committee makes Coverage Determination
Review report, Public hearing
Agencies Implement Decision
Implements within current process unless statutory conflict
Semi-annual
2-8 Months
Implications of each
Independent Clinical Committee
11 Members - 6 Physicians and 5 other health care providers
No state agency or industry representative
Clinical Committee Information Review
Must review and consider Health Technology Assessment
May consider other relevant information
Information Provided by administrator
Reports and testimony from advisory groups
Submission or comments from public
Meet Quarterly

6. HTA Program Outcome