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CMS as a Public Health CMS as a Public Health Agency: Agency:
Effective Health Care Effective Health Care
ResearchResearch
Barry M. Straube, M.D.Barry M. Straube, M.D.
Centers for Medicare & Medicaid Centers for Medicare & Medicaid ServicesServices
January 11, 2006January 11, 2006
Centers for Medicare & Centers for Medicare & Medicaid Services (CMS)Medicaid Services (CMS)
CMS as a Public Health AgencyCMS as a Public Health Agency Using CMS influence and financial leverage to Using CMS influence and financial leverage to
transform American healthcare systemtransform American healthcare system Focusing on not just Medicare & Medicaid, but Focusing on not just Medicare & Medicaid, but
also Commercial, uninsured, etc.also Commercial, uninsured, etc. Quality, Value, Efficiency, Cost-effectivenessQuality, Value, Efficiency, Cost-effectiveness Assisting patients and providers in receiving Assisting patients and providers in receiving
evidence-based, technologically-advanced care evidence-based, technologically-advanced care while reducing avoidable complications & while reducing avoidable complications & unnecessary costsunnecessary costs
Table 3.6Number of Medicare Beneficiaries, 1970-2030
25.531.0 34.1
38.6
52.2
68.2
20.4
8.6
8.7
7.3
5.4
3.3
3.0
0
10
20
30
40
50
60
70
80
1970 1980 1990 2000 2010 2020 2030
Calendar Year
Disabled & ESRD
Elderly
* Numbers may not sum due to rounding.
Source: CMS, Office of the Actuary.
The number of people Medicare serves will nearly double by 2030.
20.4
28.4*
34.3
39.6*
45.9
61.0*
76.8
Med
icar
e E
nro
llm
ent
(mil
lio
ns)
A Variation ProblemA Variation Problem
Dartmouth Atlas of Healthcare
CMS Quality RoadmapCMS Quality Roadmap
VISION: VISION: The right care for The right care for every person every timeevery person every time Make care:Make care:
Safe Safe Effective Effective Efficient Efficient Patient-centered Patient-centered TimelyTimelyEquitableEquitable
CMS Quality Roadmap: CMS Quality Roadmap: StrategiesStrategies
1.1. Work through partnerships to achieve Work through partnerships to achieve specific quality goalsspecific quality goals
2.2. Publish quality measurements and Publish quality measurements and information as a basis for supporting information as a basis for supporting more effective quality improvement more effective quality improvement effortsefforts
3.3. Pay in a way that expresses our Pay in a way that expresses our commitment to quality, and that helps commitment to quality, and that helps providers and patients to take steps to providers and patients to take steps to improve health and avoid unnecessary improve health and avoid unnecessary costscosts
CMS Quality Roadmap: CMS Quality Roadmap: Strategies for QIStrategies for QI
4.4. Assist practitioners in making care Assist practitioners in making care more effective and less costly, more effective and less costly, especially by promoting the adoption of especially by promoting the adoption of HITHIT
5.5. Bring effective new treatments to Bring effective new treatments to patients more rapidly and help develop patients more rapidly and help develop better evidence so that doctors and better evidence so that doctors and patients can use medical technologies patients can use medical technologies and treatments more effectively, and treatments more effectively, improve quality and avoid unnecessary improve quality and avoid unnecessary complications and costscomplications and costs
MMA Section 1013MMA Section 1013
Authorizes AHRQ to conduct and Authorizes AHRQ to conduct and support research with a focus on clinical support research with a focus on clinical outcomes, comparative clinical outcomes, comparative clinical effectiveness, and appropriateness of effectiveness, and appropriateness of pharmaceuticals, devices, and health pharmaceuticals, devices, and health care servicescare services
Research informed by needs of Research informed by needs of Medicare, Medicaid and State Medicare, Medicaid and State Children’s Health Insurance (SCHIP) Children’s Health Insurance (SCHIP) programsprograms
CMS Partnership with CMS Partnership with AHRQAHRQ
Jointly selected 10 conditions affecting Jointly selected 10 conditions affecting Medicare beneficiaries, with AHRQ to Medicare beneficiaries, with AHRQ to analyze effectiveness of interventions:analyze effectiveness of interventions: Ischemic heart diseaseIschemic heart disease CancerCancer Chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease Stroke, including control of hypertensionStroke, including control of hypertension Arthritis and non-traumatic joint disordersArthritis and non-traumatic joint disorders Diabetes mellitusDiabetes mellitus Dementia, including Alzheimer’s diseaseDementia, including Alzheimer’s disease PneumoniaPneumonia Peptic ulcer disease/dyspepsiaPeptic ulcer disease/dyspepsia Depression and other mood disordersDepression and other mood disorders
CMS Partnership with CMS Partnership with AHRQAHRQ
CMS represented on the review CMS represented on the review committee of proposals for the DEcIDE committee of proposals for the DEcIDE research centersresearch centers
CMS also supporting the registry project CMS also supporting the registry project which will address topics of:which will address topics of: Registry creationRegistry creation Registry operationsRegistry operations Evaluation of registry design and operationsEvaluation of registry design and operations
Dr. Clancy will review other aspects of Dr. Clancy will review other aspects of the Effective Health Care programthe Effective Health Care program
Why We Need Comparative Why We Need Comparative Effectiveness ReviewsEffectiveness Reviews
Sound foundation of evidence about which Sound foundation of evidence about which treatments work best is essential to help treatments work best is essential to help doctors and patients achieve the best quality doctors and patients achieve the best quality carecare
We need to have such evidence available in We need to have such evidence available in useful and understandable formatsuseful and understandable formats
AHRQ’s issuance of CERs are an important AHRQ’s issuance of CERs are an important milestone to achieving these goalsmilestone to achieving these goals
Beneficiaries in Medicare & Medicaid and Beneficiaries in Medicare & Medicaid and their doctors will have better information their doctors will have better information about costs and benefits of treatment for a about costs and benefits of treatment for a common health problem with multiple common health problem with multiple treatment options available treatment options available
Why We Need Comparative Why We Need Comparative Effectiveness ReviewsEffectiveness Reviews
Better evidence on what works is a Better evidence on what works is a centerpiece of the prescription drug centerpiece of the prescription drug benefit and other reforms being benefit and other reforms being implemented by CMS right now to bring implemented by CMS right now to bring the Medicare program up to datethe Medicare program up to date
We need to do more to learn about and We need to do more to learn about and measure the effectiveness of alternative measure the effectiveness of alternative treatments for common health problemstreatments for common health problems
We need to do more to help patients and We need to do more to help patients and doctors get unbiased, practically useful doctors get unbiased, practically useful information on benefits, risks, and costsinformation on benefits, risks, and costs
CMS Focus on Evidence CMS Focus on Evidence Development and UseDevelopment and Use
National and Local Coverage DecisionsNational and Local Coverage Decisions Coverage with Evidence Development (CED)Coverage with Evidence Development (CED)
Quality measures and benchmarksQuality measures and benchmarks Quality improvement initiativesQuality improvement initiatives Pay-for-Performance (P4P) programsPay-for-Performance (P4P) programs
Adoption of new medical technologies and Adoption of new medical technologies and innovationsinnovations
Medicare Compare WebsitesMedicare Compare Websites Clinical guidelinesClinical guidelines Prescription drug programPrescription drug program Medicare Advantage programMedicare Advantage program Health Information Technology, ePrescribing, Health Information Technology, ePrescribing,
etc.etc.
SummarySummary Use of better evidence in clinical care and Use of better evidence in clinical care and
health policy decision-making will:health policy decision-making will: Improve the quality of careImprove the quality of care Improve health outcomes and well-beingImprove health outcomes and well-being Achieve better value for health care dollars Achieve better value for health care dollars
spentspent Promote better health care partnerships Promote better health care partnerships
between patients and their doctors, nurses, between patients and their doctors, nurses, and other cliniciansand other clinicians
CMS looks forward to today’s session and CMS looks forward to today’s session and identifying new topics for effectiveness identifying new topics for effectiveness reviewsreviews
Contact InformationContact Information
Barry M. Straube, M.D.Barry M. Straube, M.D.
Acting Chief Medical OfficerActing Chief Medical Officer
Acting Director, Office of Clinical Standards Acting Director, Office of Clinical Standards & Quality& Quality
Centers for Medicare & Medicaid ServicesCenters for Medicare & Medicaid Services
7500 Security Boulevard7500 Security Boulevard
Baltimore, MD 21244Baltimore, MD 21244
Email: [email protected]: [email protected]
Phone: (410) 786-6841Phone: (410) 786-6841
