Comparative Effectiveness Research: Do Employers Care? What Will They Do?

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On behalf of the National Pharmaceutical Council, the Benfield Group conducted a survey in December 2010 to assess the attitudes of employers on comparative effectiveness research (CER).

Key Findings  

Employers know about CER

  • Recent momentum for CER has translated into broad awareness of CER among employers
  • Of employers surveyed, more than 75 percent were aware of CER
  • Employers care about CER and view it as a way to improve health benefit decision-making
  • Of respondents, 85 percent indicated CER research had at least “Moderate” potential to improve health benefit decisions
  • Nearly one in four indicated the potential to improve decisions is “Very Strong”

Employers know how they will use CER findings

  • More than 90 percent of employers surveyed said they will use data to develop their overall health management strategy and to formulate their medical and pharmacy benefit strategy. Fewer employers (72 percent) indicated that they use data in determining coverage and reimbursement for specific drugs.
  • When posed with hypothetical CER findings about treatment options for low back pain and diabetes, employers said they would use information in the following ways:
  • Educate and equip employees to make better decisions (73 percent back pain; 80 percent diabetes)
  • Ask health plans to change coverage and pharmacy benefits managers to change the formulary based on CER evidence (55 percent and 44 percent, respectively, for back pain; 66 percent and 73 percent, respectively, for diabetes)
  • Align incentives toward more effective treatment options (53 percent back pain; 72 percent diabetes)

Employers will primarily look to the Patient-Centered Outcomes Research Institute (PCORI) as a trusted source of CER information

Created in 2010 by the Patient Protection and Affordable Care Act, PCORI is a private, non-profit corporation to develop and fund CER and has quickly emerged as the most trusted source of CER information for employers.

  • In terms of who employers will most likely turn to for reliable information, PCORI was followed by health plan partners (56 percent), employee benefit consultants (48 percent) and health care coalitions (39 percent).
  • CER findings must include workplace-relevant information (when appropriate) to meet the needs of employers
  • Employers recognize the gap between the utility of workplace outcomes data and the availability of relevant data.
  • While fewer than one-third of employers (or their vendors) use information about absence, disability and return to work in assessing coverage for treatments, 70 percent indicate that such information would be “Important” or “Very Important” within CER. 
  • Employers are ready to support advocacy for information about workplace-relevant outcomes in CER. 
  • Of those who thought of workplace outcomes in CER as “Important” or “Very Important,” 93 percent said they would encourage their health benefit design vendor partners to advocate for inclusion in CER, and 85 percent would encourage employer health organizations to do so. 

Why employers matter to the CER conversation

  • Employers provide health insurance coverage for 170 million people, or about two-thirds of the US population.
  • Employers fund roughly one-third of all healthcare expenditures and about 40 percent of spending on prescription drugs in the US.
  • Of large employers, a majority use approaches that are designed to promote longer-term health and productivity outcomes as cornerstones of their cost management strategy, rather than focusing narrowly on reducing short-term benefit costs through price-focused negotiation and cost-shifting tactics.
  • CER will have an impact if findings are translated into practice. But the Institute of Medicine (IOM) states that it takes an average of 17 years for medical knowledge to be incorporated into clinical practice in the U.S. Employers are positioned to translate CER findings into real-world application through workplace health programs and benefit design.

About the Survey

In December 2010, the Benfield Group invited health and pharmacy benefit decision-makers and influencers to participate in a 15-minute online survey.  To supplement the 75 completed surveys, Benfield completed 25 in-depth interviews with employers (21), employer health coalition leaders (2) and employee benefit consultants (2). Among those surveyed were employee benefit directors, medical directors and other health management professionals with health management and pharmacy benefit decision-making authority or influence in large (5,000 or more employees), self-insured corporations.   

Of the 75 companies surveyed, 47 percent had more than 20,000 employees, and all companies were at least 50 percent self-insured, with 88 percent of the companies at least 75 percent self-insured.  Of respondents, 81 percent indicated they are decision-makers or influencers when it comes to employee health strategy, with the balance indicating they provide input.