不断变化的医疗环境中医疗创新的决策：来自责任医疗组织和支付方对个性化医疗及其他技术的见解。

Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

作者信息

Trosman Julia R, Weldon Christine B, Douglas Michael P, Deverka Patricia A, Watkins John B, Phillips Kathryn A

机构信息

UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Franscisco, CA, USA; Center for Business Models in Healthcare, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

出版信息

Value Health. 2017 Jan;20(1):40-46. doi: 10.1016/j.jval.2016.09.2402.

DOI:10.1016/j.jval.2016.09.2402

PMID:28212967

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5319741/

Abstract

BACKGROUND

New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs.

OBJECTIVES

To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations.

METHODS

We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis.

RESULTS

We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine.

CONCLUSIONS

As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations.

摘要

背景

新的支付和医疗组织模式，如 accountable care organizations（ACO，负责医疗组织），正在重塑问责制，将风险以及决策从支付方转移到医疗服务提供者，这一切都处于医疗改革的三重目标背景下。三重目标要求改善医疗体验、提升人群健康水平以及降低医疗成本。

目的

了解在个性化医疗和其他创新加速科学进步的时代，向 ACO 模式的转变如何影响创新技术采用和使用的决策。

方法

我们采访了 10 家参与实施 ACO 模式的私人支付方（即 ACO）和 6 家医疗机构的代表，以了解医疗创新（包括个性化医疗）决策的变化、挑战和促进因素。我们采用定性研究的框架方法进行研究设计和主题分析。

结果

我们发现，参与的支付方公司和 ACO 的代表认为，ACO 在决策方面面临类似挑战，即在改善医疗体验、提升人群健康和降低成本这三重目标的各要素之间取得平衡。这些挑战包括 ACO 决策中成本高于医疗质量考量的普遍情况，以及 ACO 评估复杂创新（如个性化医疗）的分析和技术评估能力不足。决策促进因素包括 ACO 之间竞争加剧以及患者对个性化医疗的兴趣。