Comparative Effectiveness, 2008
State of Washington
The first State Health Technology Assessment Program in the United States was implemented in the State of Washington as a result of a conference co-sponsored by AHRQ. The goal of the program is to improve health outcomes by identifying the best treatments and avoiding harmful or wasteful treatments. It accomplishes this by reviewing various medical procedures, tests, and devices for effectiveness, safety, and cost-effectiveness.
The conference, held in 2004, brought together state health policy leaders, including legislators and legislative staff, and presented them with real-life decision scenarios related to technology assessment, cost estimation, practice guidelines, and health benefits coverage decisions. The 64 conference participants became well-versed on the topic of evidence-based medicine. This helped the legislative group to understand how important evidence-based medicine is to State health policy.
Following the conference, the Agency Medical Directors Group (one of the co-sponsors) began to draft legislation to transform the conference activities into law. An important outcome was that, under the direction of the Agency Medical Directors Group, medical directors from across State agencies worked collaboratively together to draft the legislation. Helping to plan and design the program were representatives from agencies that pay for medical care for public employees and retirees; low-income and disabled citizens; and injured workers.
In 2006, evidence-based medicine became one of Washington Governor Gregoire's five-point health care strategies, and the Health Technology Assessment Program legislation was signed as the key initiative.
Leah Hole-Curry, JD, Director of the Health Technology Assessment Program, says, "The Health Technology Assessment Program serves as an independent reviewer—like Consumer Reports—rating various procedures, sorting through the hype, and summarizing the scientific evidence about whether these procedures are safe, work as claimed, and are worth the cost."
Since the implementation of the Health Technology Assessment Program in 2007, 10 technologies have been selected, and five have been evaluated by the Health Technology Clinical Committee. The Committee is made up of 11 independent, practicing health care professionals and includes six doctors and five other health practitioners. Health technologies are selected for review based on concerns about the safety of a technology, whether it is efficacious, and if it is cost-effective. A report that systematically searches for evidence and summarizes and rates the available scientific research is completed and given to the Committee.
The new program has resulted, thus far, in a ruling against covering three procedures: virtual colonoscopy, upright MRI, and discography, which is a diagnostic test for back pain. Two other procedures—pediatric bariatric (weight-loss) surgery and lumbar fusion surgery for back pain—were approved, but with substantial restrictions. These decisions result in more dollars being spent on care that has value and reducing wasteful spending on care that is unsafe or not yet proven for some or all patients and conditions.
Gary Franklin, MD, MPH, Medical Director, Washington State Department of Labor and Industries and Chair of the Agency Medical Directors Group, says, "Using evidence-based principles to decide what to do is critical to moving forward in the area of decision-making in State-purchased health care."
About 753,000 Washington patients are impacted by the program, including state and public employees and their families, Medicaid enrollees, and worker's compensation claimants. For more information, visit: http://www.hta.hca.wa.gov.
Impact Case Study Identifier: OCKT 08-01
Topic(s): Policy, Patient Safety, Cost
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Current as of September 2009
Impact Case Studies and Knowledge Transfer Case Studies: Comparative Effectiveness, 2008. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/compeff/ce2008.htm