Hoisted from my email: What’s the barrier to diffusion of cost-effective care?

I posted about a Fuchs and Milstein article in which they suggested physicians were the key to speeding up the diffusion of cost/comparative-effective care. Aaron responded with the idea that insurers ought to be interested in doing this too. That sparked some email with Kevin Outterson, which follows.

Me to Kevin:

Kevin, my question is, are insurers lacking some specific legal cover to hide behind comparative effectiveness research? Is there something about the law that isn’t helping? Is that a place to start?

Kevin, in reply (lightly edited):

It’s a collective action problem on creating and investing in comparative effectiveness research, especially with low beneficiary persistency over time (all the more reason to do it nationally); possible anti-trust (AT) issues if the plans adopt the same jointly created guidelines (they have a special AT waiver to collaborate on forms and data reporting); self-insured ERISA plans have tried with Leapfrog – not sure why that hasn’t worked better.

My conclusion:

The collective action and AT issues imply a role for government, which is another route back to politics.

So, are docs off the hook because insurers should provide the push? Are insurers off the hook because the law is a barrier and there is a collective-action problem? Or should docs provide the political cover and external motivation to solve those? (Around and around we go.)

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