Comparative effectiveness research (CER), which generated a lot of heat during the healthcare reform debate, has taken its first step forward with the publication in the Federal Register of a proposal to create a multi-payer claims database to analyze the comparative effects of different kinds of medical treatments. This research has ignited controversy because its results--while they cannot be utilized directly in Medicare coverage decisions--may affect practice patterns and what private insurers will pay for in the future.
According to the proposal by the Department of Health and Human Services, "The project represents a private/public partnership with the goal of consolidating access to longitudinal data on health services financed by both public and private payers to help facilitate CER."
Only claims data from government and private payers will be included in the database at the outset. But in the long run, the proposal says, "data with additional clinical detail from other sources, such as EHRs, may be incorporated into the database."
Authorized by the American Recovery and Reinvestment Act of 2009 (ARRA), the Multi-Payor Claims Database is one of several CER-related data infrastructure projects for which the law allocates a total of $400 million.
Interestingly, HHS contracted with Ingenix (now known as OptumInsight), a division of UnitedHealth Group, to develop the multi-payer claims database over a three-year period. While nobody has alleged that OptumInsight received this contract for any reason other than its capabilities, United is one of the nation's largest health insurers, and insurance companies are likely to be beneficiaries of comparative effectiveness research at the expense of providers.
Among the parties expected to use the CER database are researchers, health policy analysts, "key stakeholder staff and analysts within HHS," the proposal says.
As usual, there will be a 60-day comment period before HHS promulgates regulations.
To learn more:
- check out the notice in the Federal Register (.pdf)
- read this BNET article from 2009 about the CER controversy