Session 2: Discussant

Wade M. Aubry, MD, associate clinical professor, University of California, San Francisco, continues discussions saying that comparative effectiveness research (CER) and the evolution of evidence-based medicine can facilitate innovations under the Affordable Care Act (ACA), especially with the inclusion of value-based insurance design (VBID).

Dr Aubrey notes that the ACA’s aim is to address problems in the US healthcare system that leads to high costs and low-quality healthcare delivery. Several initiatives in the ACA, like CER established by the Patient-Centered Clinical Research Network Initiative (PICORI), promote evidence-based medicine which furthers the evolution of systems like pay-for-performance initiatives, and the establishment of accountable care organizations.

Under CER, specifically in managing diabetes, there is a need for better evidence regarding alternative interventions including diagnostic, therapeutic, and other systems or strategies. VBID in diabetes has the potential to incentivize high- value services, and de-incentivize low-value services. As well, ACA recommendations made by the US Preventive Services Task Force pushes screening for diabetes as a high-value preventive services that must be included in VBID health plans.

“I think the future of CER is good and that it will increasingly be applied to these types of value-based insurance designs, formularies, or medical policies with differentials copays to promote high-value care and discourage low value care,” Dr Aubry said.