![]() ![]() For example, embedding the creation of effectiveness data into the process of drug development or developing a continuous process of evidence creation in partnership with the regulators and payers might provide sufficient financial incentives to drive change. New models for product development such as evidence-based drug development will accelerate the creation of a learning healthcare system by making clear breaks with outdated approaches. Evidence generated must be put to good use through thoughtful structuring of guidelines, decision support, and outreach to providers and patients. In addition, flexibility to account for individual variation needs to be built into the system. Establishing standards of evidence and processes for reimbursement decisions would help manufacturers design better studies and work to provide the evidence needed. Rosenkrans and colleagues discuss the importance of providing incentives for appropriate evidence creation and appropriate use of evidence. Phurrough describes recent revisions of CED that define two CED components: Coverage with Appropriateness Determination and Coverage with Study Participation, as well as the range of gaps in the evidence base that such policies may help to fill. A very powerful approach taken by CMS in this respect is Coverage with Evidence Development (CED), in which reimbursement is conditional on the creation or submission of additional data. Services’ (CMS’s) opportunities for influencing change through regulatory and payment processes but also notes that its leadership in implementing policies that assist in developing evidence might encourage similar efforts throughout the healthcare system. Steven Phurrough discusses the Centers for Medicare and Medicaid ![]() ![]() Rosenberg gives several examples of past and current efforts by insurance providers to encourage evidence generation and application. For payers, incentives for change are structured around their three major functions: reimbursement, benefit plan design, and medical policy formation. These perspectives engage only a sampling of the sorts of incentives to development of a learning healthcare system, but they represent important focal points for stakeholder alignment.Īlan Rosenberg of WellPoint offers a perspective from the health insurers industry on opportunities for encouraging both evidence development and application. In this chapter, representatives from private and public payer organizations, a manufacturer, and a standards organization give their perspectives on how the field might support specific and broad policy changes that provide incentives for systemwide progress. ![]() Public and private insurers, standards organizations such as National Committee for Quality Assurance (NCQA) and the Joint Commission (formerly JCAHO), and manufacturers have the opportunity to shape policy and practice incentives to accelerate needed changes. Echoed throughout this report are calls for incentives that are structured and coordinated to drive the system and culture changes, as well as to establish the collaborations and technological developments necessary to build learning into every healthcare encounter. A fundamental reality in the prospects for a learning healthcare system lies in the nature of the incentives for inducing the necessary changes. ![]()
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