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Looking at CER from the Managed Care Organization Perspective

BACKGROUND: 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. OBJE...

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Autor principal: Cannon, H. Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2012
Materias:
Cea
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437599/
http://dx.doi.org/10.18553/jmcp.2012.18.s4-a.S13
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author Cannon, H. Eric
author_facet Cannon, H. Eric
author_sort Cannon, H. Eric
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description BACKGROUND: 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. OBJECTIVES: 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. SUMMARY: 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 expertise, hardware, software, and protocols and processes. MCOs will also need to understand how pertinent CER is to their own needs, how it may affect benefit design, and how it will affect their customers’ needs.Conclusion: Health care reform, and the resultant growth of CER, will have significant impact on MCOs, who will need to invest in better infrastructure and new understandings of a transforming market, changing customer bases, and evolving data.
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spelling pubmed-104375992023-08-21 Looking at CER from the Managed Care Organization Perspective Cannon, H. Eric J Manag Care Pharm Cea BACKGROUND: 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. OBJECTIVES: 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. SUMMARY: 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 expertise, hardware, software, and protocols and processes. MCOs will also need to understand how pertinent CER is to their own needs, how it may affect benefit design, and how it will affect their customers’ needs.Conclusion: Health care reform, and the resultant growth of CER, will have significant impact on MCOs, who will need to invest in better infrastructure and new understandings of a transforming market, changing customer bases, and evolving data. Academy of Managed Care Pharmacy 2012-05 /pmc/articles/PMC10437599/ http://dx.doi.org/10.18553/jmcp.2012.18.s4-a.S13 Text en Copyright © 2012, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Cea
Cannon, H. Eric
Looking at CER from the Managed Care Organization Perspective
title Looking at CER from the Managed Care Organization Perspective
title_full Looking at CER from the Managed Care Organization Perspective
title_fullStr Looking at CER from the Managed Care Organization Perspective
title_full_unstemmed Looking at CER from the Managed Care Organization Perspective
title_short Looking at CER from the Managed Care Organization Perspective
title_sort looking at cer from the managed care organization perspective
topic Cea
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437599/
http://dx.doi.org/10.18553/jmcp.2012.18.s4-a.S13
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