1. Cost, Evidence and Comparative Effectiveness Research Data in Benefit Design –
An Exploratory Study
Harald Schmidt
Fellow,
Fellow Kolleg Forschergruppe, Uni Münster Research Associate LSE Health
Forschergruppe Münster, Associate,
Nuffield Trust, H3 March 11

2. Objectives
• With CER push: (how) will public and private payers consider
g
value in benefit design?
• Implementation mechanisms: what’s feasible and fair?
• Within vs across disease prioritizations: potential?
• What role for public engagement?
• Patient Centered Outcomes Research Institute (PCORI): how
can it help maximize CER benefits?

3. Objectives
• With CER push: (how) will public and private payers consider
g
value in benefit design?
• Implementation mechanisms: what’s feasible and fair?
• Within vs across disease prioritizations: potential?
• What role for public engagement?
• Patient Centered Outcomes Research Institute (PCORI): how
can it help maximize CER benefits?

4. Two examples
Prostate cancer management, Plavix/Effient trial:
Policy spectrum:
• Provide all options – physician/patient judgment
• Differential copays /Value Based Insurance Design (
p y g (VBID)
)
• Other steering (information, counseling…)
• Deny coverage/access
• Other
-> Consensus: no ban, but shared decision making and use of
info.
info Over time move down the ladder (3 5 Y)
time, (3-5

5. Copays and VBID/’top-up’ payments
Pro:
• “employers need it simple” branded/generic concept clear and
y g
accepted, signaling effect
Con:
• blunt & potentially unfair (Newhouse/RAND),
(Newhouse/RAND)
• operationalizability: “just good for low hanging fruit”?
Key:
• robustness of evidence, admin cost, feasibility (co-pays used
or not… payers vs payer/provider systems)
• Fairness within group (Plavix): don’t penalize victims of
don t
genetic lottery
• Fairness across groups: Who and why? (diabetics….)
• Instead of drugs: focus on choice of providers, wellness
incentives

6. Fellowship meetings and travel oppt
and VBID/’top up’ payments
VBID/ top-up
Sept: Orientation & qualitative methods / NYC
Nov: CMWF Intl Symposium / DC
Jan: IHI/CMWF Fellow Summit / Boston
Feb: Policy mtg / DC
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May: Canada trip
June: final reporting seminar / NYC
Research related travel…