The research that PCORI funds aims to help patients and those who care for them make better-informed decisions about real-world health and healthcare issues they face. Many of those decisions involve patients, their families, and their clinicians. But other stakeholders also must consider various care approaches, such as insurers making coverage decisions, employers choosing among benefits packages, policy makers deciding on potential solutions to problems, and hospital and health-system leaders making decisions about care delivery.
To explore these topics, we asked leading representatives of several key stakeholder groups about how the kind of research PCORI supports might help them. Here is what Trent Haywood, MD, JD, Chief Medical Officer for the Blue Cross Blue Shield Association, told us.
What is the value of comparative clinical effectiveness research (CER) in helping insurers evaluate healthcare delivery and therapeutic options?
We want a healthcare system built on solid, reliable evidence. Too many healthcare interventions are not used appropriately because we don't have sufficient information about their effectiveness compared with alternatives. This leads to uneven health outcomes and wastes resources. Patients and others who pay for health care want and need to know which treatments work best, and especially which are most effective for different patients given their particular needs and circumstances. Well-designed CER can give patients and other healthcare decision makers, including payers, the information they need to confidently choose treatments that will improve health and reduce disparities.
From the perspective of insurers, what have been PCORI's greatest contributions to clinical effectiveness and outcomes-focused research?
We have to work together to improve healthcare outcomes and lower the cost of care. PCORI has played an important role in bringing the entire healthcare community to the table to figure out where CER can fill evidence gaps and help patients receive more effective, affordable, high-quality care. For decades, many healthcare sectors tried to answer these questions individually. But today, we know that we need a multi-stakeholder-driven, patient-centered approach to clinical research to improve our complex healthcare system. Bringing insurers together with industry, clinicians, employers, patients, and their caregivers is the right way to identify shared interests and opportunities to improve healthcare delivery.
PCORI has funded many studies on asthma, including a series aimed at improving adherence to national treatment guidelines. How might insurers leverage the future results of these studies to help improve patient care and outcomes?
Insurers appreciate research that can identify ways to improve adherence to evidence-based treatment guidelines by taking full account of what patients and their families want and need to know about the benefits, and potential harms, of their treatment options. For example, some research results suggest we could cut down on asthma-related emergency room visits and hospital admissions for children in crisis. This clearly would benefit the healthcare system by using available resources more effectively but the real benefit would go to patients and those who care for them.
An example of a large PCORI-funded study that will have immediate implications for insurers and the members we serve focuses on another topic, breast cancer screening. There are lingering uncertainties regarding when women should begin mammography screening and how often they should be screened. To inform these decisions, a PCORI-funded project is comparing the outcomes of women who have annual mammograms with those of women who receive mammograms on a schedule determined by their personal risk. The project, called the Wisdom Study, aims to enroll close to 60,000 women. Its results will be of great interest to insurers, clinicians, and women across the country.
What new or emerging health issues are most ripe for CER studies that could improve care delivery, patient satisfaction, and health outcomes?
The long-standing opportunity we have with CER is to better understand how we can effectively and efficiently treat health conditions that are chronic, burdensome, and costly. From low back pain to cardiovascular disease, and autism to cancer, we need better evidence that clinicians, health systems, and insurers can widely embrace and quickly integrate into everyday clinical practice. Tackling these issues through large-scale, data-driven, rapid-cycle research can provide the credible, trusted information we all seek to better guide treatment decisions.
The views expressed here are those of the author and not necessarily those of PCORI.