By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio, m.whittflicker@palio.com
There are over 100 terms and organizations officially referred to by the acronym CER. From certified emission reductions to complete engine repair and Camp Eagle Ridge, CER means many things to many people. Even in the healthcare industry, where “our favorite” CER is currently a hot and frequently debated topic, meaning and application can, and often do, take on many forms for many different stakeholders.
Comparative effectiveness research. Now, say it 3 times fast. What do we need to know about it, and how can we better understand and apply it in the world of healthcare? Since the answer to this question can probably fill at least 10 volumes of government-issue utilization reports, we must consolidate and curb our discussion. This, therefore, is the first in a series of 3 CER-focused blogs that we hope will help illuminate its history, current definition, and utilization across the spectrum of healthcare.
A brief account of a long (and often forgotten) history
The concept behind CER has been in play since the 1970s, when leaders in healthcare and federal government turned to meta-analyses, health technology assessment (HTA) and evidence-based medicine (EBM) in an effort to improve the quality, consistency, and value of interventions. These efforts have been referred to in different terms over the past 4 decades:
- 1970s: Health technology assessment
- 1980s: Effectiveness research
- 1990s: Outcomes research
- 2000s: Evidence-based medicine and comparative effectiveness research
In 2009, the American Recovery and Reinvestment Act (ARRA) set forth an expansive government-researched and funded CER initiative; $1.1 billion were allocated to 3 overseeing agencies, each commissioned with a set of comprehensive CER objectives. Since then, federal agencies such as the ARRA-established Patient-Centered Outcomes Research Institute (PCORI) continue to commission CER initiatives through normal appropriations. Private organizations are also engaging CER by funding their own initiatives.
Defining CER
In one of the most widely referenced definitions of CER, the Institute of Medicine of the National Academies (IOM) describes CER as the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policymakers to make informed decisions that will improve healthcare at both the individual and population levels.
PCORI has expanded IOM’s definition by including the assessment of benefits and harms of varying interventions and strategies in real-world settings. Interventions and strategies considered in CER may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral changes, and delivery systems. CER initiatives should focus on patient-centered research to provide evidence-based information to patients, physicians, policymakers, and anyone else who needs to make a decision about healthcare. CER is designed to develop information that helps these parties make informed decisions about the appropriate options for individual patients and patient populations.
Some benefits of CER
CER aims to examine and illuminate the patient experience — including varying life experiences, medical histories, and values — in different healthcare environments, such as private medical practices, hospitals, pharmacies, and outpatient programs. Evidence produced by comprehensive CER studies may be utilized to help reduce the frequency of clinician error, and it may also improve patient awareness. Information derived from CER initiatives may help healthcare professionals be more consistent, transparent, and rational in diagnosing illness and prescribing treatment.
The future of CER
CER is anticipated to be an increasingly important tool across the spectrum of healthcare.
High-impact disease states and underrepresented populations will continue to be an important focus of CER initiatives in the United States due, in part, to the growing prevalence rates in nonwhites for major disease states like type 2 diabetes and HCV.
For managed care decision-makers, there is a growing recognition of the potential role that CER can provide for patients, physicians, and payers alike.
In upcoming CER blogs, we’ll take a look at CER study design (advantages and disadvantages of applied methodologies and outcomes) as well as specific examples of CER utilization in private managed care organizations.
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