Comparative Effectiveness Research and Health Reform in the USA

Abstract

The Affordable Care Act (ACA), contains several provisions that work together to promote the development of comparative effectiveness research (CER) as a means to control costs and improve patient care. The most important of these creates a new independent nonprofit entity known as the Patient-Centered Outcomes Research Institute (PCORI) with a mission to advance CER as a discipline. Related provisions in the ACA create new bodies to improve care and control costs under Medicare. A base for PCORI’s work was established by the American Recovery and Reinvestment Act of 2009 (ARRA), which implemented new funding for CER and encouraged the use of electronic health records (EHRs) by providers. However, the ACA also limits PCORI’s mission by prohibiting it from considering costs in its analyses and preventing Medicare from using the results in coverage determinations. These restrictions stem from political disputes that preceded the ACA’s passage and that continue even after its implementation. For PCORI to succeed, it will have to remain attentive to aspects of the broader policy and political context in which CER is conducted. If it effectively does so, it can establish CER as an important tool in building the future of American health care.