EBRI Argues for Benefit Design Linked with Evidence-Based Medicine

February 16, 2006 (PLANSPONSOR.com) - Using the best available evidence to make medical care decisions for patients could produce notable improvements to the nation's health care system, according to the nonpartisan Employee Benefits Research Institute (EBRI).

EBRI said in its recent study that the concept of evidence-based medicine can be more explicitly linked with changes in health plan design to better focus on health improvements and to discourage services and costs that do not result in improved patient health. Evidence-based medicine requires the integration of clinical expertise with evidence from systematic research to achieve the best outcome for each patient, EBRI said in a news release.

The better use of evidence in health plan coverage design could reduce the use of marginal services and control some of the variation in utilization among providers, the study said. EBRI noted that efforts to move in this direction have met with obstacles. Major obstacles to the use of evidence-based medicine include a perceived lack of sufficient evidence to proceed, credibility and transparency issues, benefit design language, financial relationships,and administrative costs, according to the study.

EBRI suggests benefit plan language that better integrates evidence, encourages its use, rewards improvement in the quality of evidence, and provides more precision for decision makers. The study says evidence is essential to consumer-driven health plans since cost sharing with employees sometimes results in the reduction of utilization of valuable health care services as much as unnecessary services.

In the study the state of Oregon is given as one example of progress toward a greater use ofevidence-based medicine. Oregon has developed a language of health benefitdesign that is organized around combinations of conditions and treatments that use medical evidence in determining covered conditions and approved treatments. The study reports that health plans currently administering the Oregon Health Plan for Medicaid patients have been profitable over the course of several changes in the plan.

The EBRI study can be downloaded from here .