PMID: 22578213May 18, 2012Paper

Looking at CER from the managed care organization perspective

Journal of Managed Care Pharmacy : JMCP
H Eric Cannon

Abstract

The amount of available comparative effectiveness research (CER) is increasing, giving managed care organizations (MCOs) more information to use in decision making. However, MCOs may not be prepared to integrate this new and voluminous data into their current practices and policies. To describe ways that health care reform will affect MCO populations in the future, to examine examples of how MCOs have utilized CER data in the past, and to identify questions that MCOs will have to address as they integrate CER into future decision making. Unquestionably, health care reform will change the U.S. market. Millions more insured individuals will be making purchasing decisions. In addition, health care reform will mean more CER data will be available, affecting the decisions MCOs must make. In the past, MCOs may not have used CER as effectively as they could in making formulary and other policy decisions. However, there are examples that show how CER can be integrated effectively, such as Intermountain Healthcare's use of CER to create treatment guidelines, which have been shown to lower costs and improve delivery of care. In the future, MCOs will need to assess their own abilities to utilize CER, including their infrastructure of expe...Continue Reading

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