CMS as a Public Health Agency: Effective Health Care Research

1. CMS as a Public Health Agency: Effective Health Care Research Barry M. Straube, M.D. Centers for Medicare & Medicaid Services January 11, 2006

2. Centers for Medicare & Medicaid Services (CMS) • CMS as a Public Health Agency • Using CMS influence and financial leverage to transform American healthcare system • Focusing on not just Medicare & Medicaid, but also Commercial, uninsured, etc. • Quality, Value, Efficiency, Cost-effectiveness • Assisting patients and providers in receiving evidence-based, technologically-advanced care while reducing avoidable complications & unnecessary costs

3. Table 3.6 Number of Medicare Beneficiaries, 1970-2030 The number of people Medicare serves will nearly double by 2030. 76.8 61.0* 45.9 Medicare Enrollment (millions) 39.6* 34.3 28.4* 20.4 * Numbers may not sum due to rounding. Source: CMS, Office of the Actuary.

6. A Variation Problem Dartmouth Atlas of Healthcare

8. CMS Quality Roadmap • VISION: The right care for every person every time • Make care: • Safe • Effective • Efficient • Patient-centered • Timely • Equitable

9. CMS Quality Roadmap: Strategies • Work through partnerships to achieve specific quality goals • Publish quality measurements and information as a basis for supporting more effective quality improvement efforts • Pay in a way that expresses our commitment to quality, and that helps providers and patients to take steps to improve health and avoid unnecessary costs

10. CMS Quality Roadmap: Strategies for QI • Assist practitioners in making care more effective and less costly, especially by promoting the adoption of HIT • Bring effective new treatments to patients more rapidly and help develop better evidence so that doctors and patients can use medical technologies and treatments more effectively, improve quality and avoid unnecessary complications and costs

11. MMA Section 1013 • Authorizes AHRQ to conduct and support research with a focus on clinical outcomes, comparative clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services • Research informed by needs of Medicare, Medicaid and State Children’s Health Insurance (SCHIP) programs

12. CMS Partnership with AHRQ • Jointly selected 10 conditions affecting Medicare beneficiaries, with AHRQ to analyze effectiveness of interventions: • Ischemic heart disease • Cancer • Chronic obstructive pulmonary disease • Stroke, including control of hypertension • Arthritis and non-traumatic joint disorders • Diabetes mellitus • Dementia, including Alzheimer’s disease • Pneumonia • Peptic ulcer disease/dyspepsia • Depression and other mood disorders

13. CMS Partnership with AHRQ • CMS represented on the review committee of proposals for the DEcIDE research centers • CMS also supporting the registry project which will address topics of: • Registry creation • Registry operations • Evaluation of registry design and operations • Dr. Clancy will review other aspects of the Effective Health Care program

14. Why We Need Comparative Effectiveness Reviews • Sound foundation of evidence about which treatments work best is essential to help doctors and patients achieve the best quality care • We need to have such evidence available in useful and understandable formats • AHRQ’s issuance of CERs are an important milestone to achieving these goals • Beneficiaries in Medicare & Medicaid and their doctors will have better information about costs and benefits of treatment for a common health problem with multiple treatment options available

15. Why We Need Comparative Effectiveness Reviews • Better evidence on what works is a centerpiece of the prescription drug benefit and other reforms being implemented by CMS right now to bring the Medicare program up to date • We need to do more to learn about and measure the effectiveness of alternative treatments for common health problems • We need to do more to help patients and doctors get unbiased, practically useful information on benefits, risks, and costs

16. CMS Focus on Evidence Development and Use • National and Local Coverage Decisions • Coverage with Evidence Development (CED) • Quality measures and benchmarks • Quality improvement initiatives • Pay-for-Performance (P4P) programs • Adoption of new medical technologies and innovations • Medicare Compare Websites • Clinical guidelines • Prescription drug program • Medicare Advantage program • Health Information Technology, ePrescribing, etc.

17. Summary • Use of better evidence in clinical care and health policy decision-making will: • Improve the quality of care • Improve health outcomes and well-being • Achieve better value for health care dollars spent • Promote better health care partnerships between patients and their doctors, nurses, and other clinicians • CMS looks forward to today’s session and identifying new topics for effectiveness reviews

18. Contact Information Barry M. Straube, M.D. Acting Chief Medical Officer Acting Director, Office of Clinical Standards & Quality Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Email: Barry.Straube@cms.hhs.gov Phone: (410) 786-6841