Medical Technology and Medical Policy Formation. Medical Device Regulatory, Reimbursement and Compliance Congress March 27, 2008. Alan Rosenberg, M.D. Vice President, Medical Policy, Technology Assessment and Credentialing Programs. Medical Technology and Medical Policy Formation.
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Medical Device Regulatory, Reimbursement and Compliance CongressMarch 27, 2008
Alan Rosenberg, M.D.Vice President, Medical Policy, Technology Assessment and Credentialing Programs
New Haven, CT
Terre Haute, IN
Note: Data represents 2003 Incurred dates for Fully Insured, Group Business only
Source Data Capture
How does WellPoint evaluate reported information in the determination of medical policy?
Annual Policy Review
Changing Practice Patterns
New TEC Findings
- External Engagement
- Decision Making
Academic Medical Centers
Trigger New or Revised Policy
Health Plan Research & Evaluation of Evidence
Request by Network Providers
Request by Specialty Societies
Request by Practicing Experts
Request by Vendors
Review by HEM/ONC
Review by MPTAC*
Review by Behavioral Health
Monitor Policy Outcomes
Posting Policy Positions on the Internet
MPTAC Adoption of Policy Position
*The Hematology/Oncology Committee¹ (HEM/ONC), Medical Policy & Technology Assessment Committee² (MPTAC) and Behavioral Health Committee³ include external physician representation
Some key issues regarding use of measurement and metrics in the determination of Medical Policy
Agency for HealthCare Research and Quality (AHRQ) Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer Executive Summary published 5 Feb 2008
Cardiac CT Imaging:
Technology Assessment Program
Agency for Healthcare Research and Quality
Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging: Appropriateness CriteriaType: Appropriateness Criteria Reference: J Am Coll Cardiol 2006
New England Journal of Medicine 357:2666-2676December 27, 2007
Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast CancerKathy Miller, M.D., Molin Wang, Ph.D., Julie Gralow, M.D., Maura Dickler, M.D., Melody Cobleigh, M.D., Edith A. Perez, M.D., Tamara Shenkier, M.D., David Cella, Ph.D., and Nancy E. Davidson, M.D.
Results: Paclitaxel plus bevacizumab significantly prolonged progression-free survival as compared with paclitaxel alone (median, 11.8 vs. 5.9 months). The overall survival rate, however, was similar in the two groups (median, 26.7 vs. 25.2 months). Grade 3 or 4 hypertension (14.8% vs. 0.0%, P<0.001), proteinuria (3.6% vs. 0.0%, P<0.001), headache (2.2% vs. 0.0%, P=0.008), and cerebrovascular ischemia (1.9% vs. 0.0%, P=0.02) were more frequent in patients receiving paclitaxel plus bevacizumab. Infection was more common in patients receiving paclitaxel plus bevacizumab (9.3% vs. 2.9%, P<0.001), but febrile neutropenia was uncommon (<1% overall).
Compound measures that mix clinically significant measures with other measures and create a statistically significant result that is not achieved based on the clinically significant measure alone
"Make everything as simple as possible, but not simpler.“
“I would not give a fig for the simplicity this side of complexity, but I would give my life for the simplicity on the other side of complexity.”
Oliver Wendell Holmes