Real-World Evidence- Useful in the Real World of US Payer Decision Making? How? When? And What Studies?

Mar 1, 2018, 00:00
10.1016/j.jval.2017.08.3013
https://www.valueinhealthjournal.com/article/S1098-3015(17)33347-8/fulltext
Title : Real-World Evidence- Useful in the Real World of US Payer Decision Making? How? When? And What Studies?
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(17)33347-8&doi=10.1016/j.jval.2017.08.3013
First page : 326
Section Title : HEALTH POLICY ANALYSIS
Open access? : No
Section Order : 11

Objectives

To examine how real-world evidence (RWE) is currently perceived and used in managed care environments, especially to inform pharmacy and therapeutic (PT decision making.

Methods

We conducted focus groups/telephone-based interviews and surveys to understand perceptions of RWE and assess awareness, quality, and relevance of two high-profile examples of published RWE studies. A purposive sample comprised 4 physicians, 15 pharmacists, and 1 researcher representing 18 US health plans and health system organizations.

Results

Participants reported that RWE was generally used, or useful, to inform safety monitoring, utilization management, and cost analysis, but less so to guide PT decisions. Participants were not aware of the two sample RWE studies but considered both studies to be valuable. Relevant research questions and outcomes, transparent methods, study quality, and timely results contribute to the utility of published RWE. Perceived organizational barriers to the use of published RWE included lack of skill, training, and timely study results.

Conclusions

Payers recognize the value of RWE, but use of such studies to inform PT decisions varies from organization to organization and is limited. Relevance to payers, timeliness, and transparent methods were key concerns with RWE. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations.

Categories :
Tags :
  • health care decision making
  • observational research
  • payer
  • real-world evidence
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