The Blue Cross and Blue Shield Association last week called on Congress to create an independent institute tasked with studying medical procedures, techniques, drugs and devices, and determining which work best, a move that received a mixed response from industry players.
The Chicago-based umbrella organization for 39 for-profit and not-for-profit Blues plans said it was willing to help fund the estimated $500 million operations of the institute, but not the whole tab. The association also called for Medicare, Medicaid and other government-funded payers to kick in financially.
However, some in the industry question whether such an effort can be independent enough to do its job properly. This is a function that the government ought to be filling, said Peter Lurie, deputy director of Public Citizens Health Research Group. The concern would be, as long as part of the funding is private, the private funders might be pulling the strings as to what products get studied and how.
The Blues organization is not alone in the insurance industry in making such a plea for more research. A similar call for an independent research organization was made last month by Americas Health Insurance Plans, a Washington-based trade group for the health insurance industry that counts among its members a majority of the Blues-affiliated health plans. The key difference is that AHIP didnt attach a price tag, according to AHIP spokesman Mohit Ghose.
Both seek to create an independent, public-private organization that would perform research in some areas already being addressed by a relatively new program under the federally funded Agency for Healthcare Research and Quality.
The Blues association said the proposed institute was an important component of a multipronged strategy it will be announcing in the coming months to improve healthcare value and quality for consumers, according to a statement it released last week.
Its unclear if the Blues plan has enlisted a member of Congress to introduce a bill to create the institute. By deadline, Blues officials did not respond to several calls for more details about its plan.
According to the Blues proposal, the institute would support research into the efficacy of new vs. existing medical procedures, drugs, devices and biologics. It would be governed by a board of directors whose members would be drawn from both the public and private sectors. A stable funding mechanism would be required, according to the Blues organization, which proposes assessing all private payers as well as publicly funded programs such as Medicare and Medicaid.
In a prepared statement, Blues President and Chief Executive Officer Scott Serota said obtaining credible information on the most effective treatments holds the most promise for improving the value and quality of our system.
According to the text of a speech at the National Press Club in Washington, Serota estimated the institute will cost $500 million in its first year, a substantial amount, but only a fraction of the nations more than $2 trillion in annual health expenditures. Serota said the Blues will pay our fair share, but did not specify how much.
The type of research called for in the proposal is in great demand. Do we need a substantial investment in comparative research? The answer is clearly yes, said Elliott Fisher, a professor at Dartmouth Medical School. Fisher also served as co-chairman of an IOM subcommittee on performance measures.
The question of who should pay for this is a separate matter, Fisher said. Curbing undue payer influence needs to be dealt with when the institute is structured. Most importantly, it should be an independent entity, he said.
The government already is working on the type of goals outlined by the Blues, but its funding is currently much lower than what the Blues estimated.
Lurie, who objects to insurance industry funding for the group, noted that Public Citizen also opposes a portion of the Blues proposal that would give safe harbor from noneconomic and punitive damages in medical malpractice lawsuits to physicians who rely on practice guidelines established through the institutes research.
Thats just a sop to physicians and the insurance companies, Lurie said.