Outcomes And Effectiveness Research In The Private Sector

PROLOGUE: Practically since its inception, the Agency for Health Care Policy and Research (AHCPR) has been a target of budget-cutting Congressmen. To take one recent example, in May 1998 the House Budget Committee proposed a $90 million reduction in AHCPR's annual budget—a substantial sum when one considers the fact that the agency's current budget is a fairly modest $146 million. Underlying this proposal was the committee's belief that the agency duplicates private-sector activity in the area of medical practice standards and guidelines. Contrary to what some in Congress might believe, Dan Mendelson and colleagues report that, although there is considerable private-sector activity under way in this area, government's role is by no means obviated by this activity. The authors boast a wealth of experience in the field of science and technology policy, with scores of journal articles to their credit. Mendelson recently became the associate director for health at the Office of Management and Budget. Prior to entering government, Mendelson spent eight years with the Lewin Group in Fairfax, Virginia, where he was most recently senior vice-president and director of the medical technology practice. He holds a master's degree from Harvard's Kennedy School. Cliff Goodman is a senior manager with the Lewin Group. He earned a doctorate from Pennsylvania's Wharton School. Robert Rubin, president of the Lewin Group, earned his medical degree from Cornell University. Roy Ahn was an associate in the medical technology practice at the Lewin Group when this paper was written. He holds a master's degree from Yale University. ABSTRACT: Private-sector health care organizations increasingly tout the use of outcomes and effectiveness research in activities ranging from pharmaceutical research to insurance coverage determinations. The rapid development of this research raises important questions about the role of the Agency for Health Care Policy and Research (AHCPR) as the producer, funder, and champion of outcomes and effectiveness research. To address this issue, we reviewed the activities of pharmaceutical companies, insurers, managed care organizations, health information technology companies, and other private-sector actors in outcomes and effectiveness research. We found that it is being used in a focused way to promote business goals and other organizational objectives, particularly in the pharmaceutical, insurance, and managed care industries. We also found significant gaps in its application to important public health issues and virtually no overlap with prior federal activities in this area.