Background A state passed comprehensive health reform legislation in 2009 that directed it to develop a process to translate evidence into coverage guidance to be applied rapidly and uniformly across public and private healthcare payers. A Governor-appointed committee managing the state’s Medicaid benefit package developed an analytic framework with a decision algorithm to facilitate coverage decisions. The framework is built upon six decision point priorities: sufficiency of evidence, effectiveness of the treatment and availability of alternatives, treatment risk, cost, prevalence of treatment and research feasibility.
Objectives/Goal To practice applying decision-making principles and best available evidence to reach coverage decisions.
Target Group, Suggested Audience Policy makers, guideline developers and users.
Description of the Workshop and of the Methods used to Facilitate Interactions A short didactic presentation will present the analytic framework development history. We will discuss alternative priorities that could have been adopted. Participants will then work in facilitated small groups to reach coverage decisions using the framework and algorithm. Each small group will have a summary of the evidence available. The topics will include surgery for femoroacetabular syndrome, carotid endarterectomy and treatment of attention deficit hyperactivity disorder. Facilitators will encourage participants to attempt to reach a coverage decision as if they were a policy-making body and will assist with interpretation of the evidence. The group will identify and consider any potential implementation barriers or considerations and propose management strategies. The groups will share their experience using the framework and the facilitators will present the actual decisions the state committee made.
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