Sean Tunis, Steve Phurrough and Penny Mohr collaborated with Robert Berenson of the Urban Institute to develop an Issue Brief to describe the recently articulated “Triple Aim” of the Medicare program to (1) improve the individual experience of care, (2) improve the health of populations, and (3) reduce per capita costs of care for populations. According to the authors, much of the focus of the Triple Aim has been on providers of health services. However, they argue, there is a role for payers also. Medicare coverage determinations “can act as a policy lever to influence both the appropriate use of medical technology and the creation of better evidence to support clinical and health policy decisions.” The authors describe how, in the current medical technology marketplace, new technologies are often adopted with little evidence that they represent any improvement over existing technologies, and with scant evidence of whom the new technology might benefit or harm. Meanwhile, due to a range of factors detailed in the Brief, including the structure of the Medicare decision-making system, the statutory language from which the Centers for Medicare and Medicaid (CMS) derive their authority, fiscal and political pressures, and other factors, CMS coverage determinations fall short of achieving the goals of the Triple Aim. Following an analysis of the barriers to more effective decision-making, the authors offer a series of timely and bold proposals for operational and policy changes calibrated to improve CMS’s ability to promote better evidence for new technologies which in turn can improve health and care.
Click link below for the summary and issue brief,
Click here for the summary and issue brief (pdf) (271.05 kB)