Blue Cross Proposes Payer-Funded Group To Evaluate Medical Treatments

The Blue Cross and Blue Shield Association (BCBSA) on Monday called upon Congress to enact legislation to establish a new, independent institute – funded by all healthcare payers – to provide consumers and providers with much needed information on which medical treatments work best.

Officials said, “This proposal is an important component of a multi-pronged strategy BCBSA will be announcing in the coming months to improve healthcare value and quality for consumers.”

It is estimated that up to 30 percent of healthcare spending pays for ineffective, inappropriate or redundant care, Blue Cross officials said.

They stated, “As policymakers debate how best to reform our healthcare system, BCBSA believes it is critical to start by developing the knowledge base to empower patients and providers with credible information to ensure the delivery of appropriate and timely care.”

Under BCBSA’s proposal, the institute would support research comparing the effectiveness of new and existing medical procedures, drugs, devices, and biologics. The institute would support “a broad range of research, including much-needed clinical trials, and be governed by a board representing stakeholders in the government and private sector.”

Officials said, “The most significant barrier to creating a new institute is establishing a significant and stable funding source. BCBSA proposes funding the institute by assessing all private (insured and self-funded) and public healthcare coverage such as Medicare, Medicaid, and other government programs. BCBSA, as a leading provider of healthcare coverage to more than 98 million people, is prepared to contribute substantial financial support to the initiative.”

“Credible information on what treatment works best holds the most promise for improving the value and quality of our system,” said Scott P. Serota, BCBSA president and CEO. “Today, patients often are paying for sub-optimal care. This institute is an important step to assuring that we are providing the best incentives to deliver the best care.”

To ensure the new research improves clinical practice, significant education and incentives will be needed, it was stated.

BCBSA recommends that the new comparative information be quickly and efficiently disseminated to providers, patients, and others, and that the research results be incorporated into clinical practice guidelines through close collaboration with medical societies.

“New research on the effectiveness of different treatments offers promise in addressing many significant issues including access to care and affordable coverage, improving healthcare quality and safety, and increasing transparency and accountability,” said Debra Ness, president of the National Partnership for Women & Families. “I’m pleased that the institute will translate its research into language that consumers can understand. Consumers need this kind of information so that together with their providers, they can make more informed decisions about their healthcare.”

Another important element of the proposal calls for physicians who rely on practice guidelines established through the institute’s research to be given safe harbor for non-economic and punitive damages when faced with claims of medical malpractice, it was stated.

“The institute would close critical gaps in our medical understanding of the efficacy of certain treatments and, in the end, improve the quality of care for America,” said Dr. John Fallon, chief physician executive, Blue Cross Blue Shield of Massachusetts. “Collaboration among key stakeholders, including providers and consumers, will be essential to the success of this effort.”
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