CER Scoring Framework

1
CER Scoring Framework

• Avalere Health
• December 2007

2
Comparative Effectiveness Research Will Be Most
Sustainable if

• Governing body that balances political influence
  and accountability
• Defined funding source
• Improved health outcomes
• Attributable savings

3
Theoretical Costs and Savings Associated with CER
Year 10
Federal Spending ()
Year 2
Year 20
Start-up and administrative costs
Behavior change as a result of research
Research costs
Behavior change as a result of payment and
coverage incentives
The height, length, and slope of the graph is
dependent on the scope and approach of a CER
proposal
4
Potential Costs and Savings Will Be Determined
by Design Characteristics of CER Proposals
Who will sit on the advisory board?
Governance
Funding
Infrastructure
How will the initiative be funded?
What type of entity is created? Where is it
placed?
Structure
Which health care services are included in the
research agenda?
Scope
Which research methods will be employedprimary,
secondary, combination?
Analysis Methodology
Implementation
Inclusion of Economic Information
Which factors will be included/ prioritized?
How will the results be applied and whose
behavior will be targeted?
Impact Measurement
Efficiencies
How will effects of CER be monitored, measured,
and attributed?
5
Theoretical Costs and Savings Associated with CER
100
Health system efficiencies
Federal Spending ()
Scope and Methodology
Physician discounting of research could mean that
no savings are realized
Disruptive technologies could enter market before
savings are realized
Governance, Funding, and Structure
0
Start-up and administrative costs
Behavior change as a result of research
Research costs
Behavior change as a result of payment and
coverage incentives
The height, length, and slope of the graph is
dependent on the scope and approach of a CER
proposal
6
Legislation Will Define Governance and Impact
Entitys Operations
7
Various Funding Mechanisms Will Determine
Sustainability and Independence of CER Entity
Low
Automatic or Dedicated Funding Mechanism
Taxes
Proposed Center for Comparative Effectiveness
(Section 904 CHAMP 2007)
Outside Influence
Annual Appropriations
AHRQ Effective Healthcare Program (Section 1013
of MMA 2003)
Private Contributions
High
Stability of Funding
Low
High
8
Decisions About Structure Will Impact Investment
Requirement

New Government Agency
Expansion of Existing Agency
Expansion of AHRQ or NIH
Quasi-governmental
Federal Investment
Institute of Medicine
Public-Private Partnership
National Quality Forum

Government
Membership Based
9
CER Methodologies Require Different Investments
and Promise Varying Levels of Savings
Prospective Clinical Trials
Observational Studies
Systematic reviews
Federal Spending ()
0
Time
(years)
-20
Time and relative costs and savings are
theoretical and meant for illustrative purposes.
10
Inclusion of More Areas for Research Increases
Amount of Spending that Can Be Targeted and
Potential Savings
Distribution of Health Services and Supplies
Spending
Other
10
Hospital Care
Government Admin
32
and Public Health
Activities
15
Nursing Home and
Home Health
9
Physician and Clinical
Prescription Drugs
Services
11
23
Source Avalere Health analysis of National
Health Expenditure Data for 2005.
11
Manner of Adoption of Findings into Clinical Care
Will Impact Magnitude of Potential Savings
Coverage Decisions
Reimbursement Changes
Benefit Design
Decision Support Tools
Potential to Create Savings
Dissemination
Payer Mandate
Patient/Physician Choice
12
CER Stakeholders
13
CER Influencers