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John Santa MD MPH, Health Advisor/Consultant

John Santa MD MPH, Health Advisor/Consultant. April 2008. The Problem. Half of what doctors do is evidence-based. Unnecessary care harms patients and wastes $$$. System poorly organized for comparing treatments and providers. Consumers are lost in the maze.

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John Santa MD MPH, Health Advisor/Consultant

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  1. John Santa MD MPH, Health Advisor/Consultant April 2008

  2. The Problem • Half of what doctors do is evidence-based. • Unnecessary care harms patients and wastes $$$. • System poorly organized for comparing treatments and providers. • Consumers are lost in the maze. • Conflict-of-interest is rife in health care. • Doctors lack information to make the best possible clinical decisions. • Consumers lack information to choose among treatment and provider options.

  3. Barriers to Change • Comparative effectiveness research is very expensive. • Aggregation of data and findings is hard. • Data is inconsistent across states, health plans, benefit designs. • Some companies resist sharing data. • Doctors are hard to reach and influence. • Consumers are skeptical, worry about access being blocked. • Some industries fanning consumer fears.

  4. Our mission since 1936 … an expert, independent, nonprofit, nonpartisan organization, whose mission is to work for a fair, just, and safe marketplace for all consumers. What we do:test, inform and protect. Consumer Reports

  5. Our Approach • Consumers want trustworthy, easy-to-understand, actionable information. • No commercial agendas, advertiser influences or financial relationships. • Involve consumers from the outset in choosing topics for evaluation and effective translation methods. • Work with advisors and groups who are independent and unbiased. • Consumers love ratings!

  6. Our Health Ratings to Date • Health Plans • Nursing Homes • Health Care Products & Devices • Nutritional Supplements • Medical Treatments • Prescription Drugs

  7. What We Found • Cholesterol Drugs – For most people, new generics are just as good. • Alzheimer’s Drugs – Not very effective in preventing mental decline. • Diabetes Drugs – Newer, expensive medications are no better and less safe. • Heartburn Drugs – Over-the-Counter drugs just as good as expensive brands.

  8. Millions view information on www.CRBestBuyDrugs.org or other partner Web sites. • Medco uses CRBBD content. In one initiative, 4.3% of statin users switched to lower-cost generics. Savings: $8 million. • The Wisconsin Education Association Trust also used CRBBD materials. Savings: $455,000 from switch to lower-cost heartburn drugs.

  9. Policy Issues • Need reliable source of ongoing funding for comparative effectiveness research. • Test ways to incorporate comparative effectiveness into benefit design and reimbursement. • Target funding at consumer friendly “translations” and dissemination. • Payment reform must reward providers for using evidence-based practices. • Explore tiered co-pays to reward consumers for choosing evidence-based care.

  10. Policy Issues • Eliminate conflict-of-interest at critical decision points (training, research, regulation, purchasing, point of care). • Create more conflict-free independent “islands” of health research and delivery, like DERP and AHRQ’s Evidence-Based Practice Centers. • Educate consumers on what “transparency” really means to them. • Deploy HIT & e-Rx to dramatically improve patient safety.

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