Testimony on Comparative Effectiveness Research

Samuel Lin, American Medical Group Association

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On April 3, 2009, public testimony on comparative effectiveness research was given at a meeting of the National Advisory Council for Healthcare Research and Quality. The testimony represents the views of the presenter and not necessarily those of the Agency for Healthcare Research and Quality (AHRQ) or the Department of Health and Human Services (HHS).

The Council provides advice and recommendations to the Director, AHRQ, and to the Secretary, HHS, on priorities for a national health services research agenda.

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WRITTEN TESTIMONY
SAMUEL LIN, MD, PhD, MBA, MPA, MS
AMERICAN MEDICAL GROUP ASSOCIATION

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
NATIONAL ADVISORY COUNCIL MEETING
COMPARATIVE EFFECTIVENESS RESEARCH

April 3, 2009

I am Sam Lin, a Family Physician, representing the American Medical Group Association based in Alexandria, Virginia. AMGA is a professional medical association representing some of this nation's largest, best known, and prestigious integrated health care delivery systems. More than 95,000 physicians practice in AMGA member organizations and provide health care services for approximately 95 million patients.

Today, in the context of the Comparative Effectiveness Program to be funded by AHRQ, you are hearing comments with a focus on several disease conditions and treatments. And while critical to the discussion, it is imperative that we also examine the context for this care. Unless the delivery system is considered, we otherwise would continue to promote fragmented care, leaving patients to wander on their own. AMGA supports the fundamental concepts of comparative effectiveness information use in health care delivery, but we also believe that delivery systems matter. There is an emerging body of evidence that supports this idea, and it is also being tested in several CMS demonstration projects. We strongly recommend that this Advisory Council consider comparative effectiveness in its broadest terms, not limited to research on treatments and devices alone.

CER should be undertaken for quality, effectiveness, and other appropriate dimensions for health care delivery systems along the entire spectrum of systems integration. This spectrum should include integrated delivery systems, multi-specialty group practices, single-specialty groups, "virtual" groups such as IPAs, PHOs, and small medical practices (solo, duo, small groups), and perhaps others.

Use of comparative effectiveness information on delivery systems would facilitate and strengthen provision of patient care, disease states, and related financial determinations. By knowing what works best in treating patients, the nation's healthcare delivery system could make substantial strides toward improving clinical outcomes, closing gaps in geographic variations, while reducing health care expenditures. While we favor CER, we temper that view with caution that such information must be objective, developed by disinterested parties, and should be equally applied. 

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