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Health Technology Assessments Vital to Payers for Defensible Coverage Determinations
Patient Safety

Health Technology Assessments Vital to Payers for Defensible Coverage Determinations

In today's healthcare environment, payers are under increasing pressure to make new and updated medical policy determinations as quickly and cost-effectively as possible.

Health technology assessments (HTAs) can provide a synthesis of the relevant evidence-based clinical literature to enable payers to make informed decisions about whether or not to cover a new medical technology. In this article, we'll explore the importance of HTAs for payers in developing strong, defensible coverage decisions.

What is a health technology assessment?

A HTA is a systematic evaluation of a technology's efficacy, safety, and cost-effectiveness. There are various HTA methods, but all HTAs share a common goal: to provide a fair and objective evaluation of a technology's benefits and risks based on the published clinical literature. This information can be used to help policymakers, clinicians, and healthcare leaders make informed decisions about whether or not to adopt a new technology. 

HTAs are conducted by government agencies, private companies, and independent, nonprofit organizations such as ECRI. They can be used to assess a wide range of health technologies, including drugs, medical devices, diagnostics, procedures, and genetic tests. 

HTAs are an important part of the drug and device approval process. They can help regulators make informed decisions about whether or not to approve a new technology. HTAs are also used to inform coverage decisions by private insurers and government programs such as Medicare and Medicaid.

Why are HTAs important for making defensible policy coverage decisions?

The use of HTAs has been increasing in recent years, as payers and other healthcare decision-makers face increasing pressure to make evidence-based decisions about which technologies deliver the safest and most effective care. There are many reasons why using HTAs in coverage decisions is important; HTAs can help:

  1. Ensure that payers are making coverage decisions based on peer-reviewed clinical literature.

  2. Make decision-makers aware of the latest evidence of a technology's benefits and harms.

  3. Measure the strength and quality of the available evidence base.

  4. Identify gaps in the evidence and potential bias in the study design.

  5. Measure the potential cost effectiveness of a technology.

  6. Identify adverse events and safety concerns stemming from the technology’s use on patients.

  7. Determine the potential implementation challenges of a technology.

  8. Ensure that payers are making informed decisions about which technologies to cover. 

An HTA is an essential tool for payers when making defensible coverage determinations. The assessment process is designed to inform coverage decisions and healthcare policy development. In this way, HTAs allow payers to make rational, well-informed decisions about which health technologies to cover and how to balance coverage with cost-effective considerations.

When making coverage decisions, payers need to consider multiple factors including:

  1. Patient access

  2. Clinical effectiveness

  3. Cost-effectiveness

  4. Safety

It also provides a comprehensive and objective assessment of these factors and allows for a more informed decision-making process. 

HTAs can provide payers with a better understanding of the safety and efficacy of health technologies. They can help you provide evidence-based recommendations for specific treatments and interventions. This information can be used to create evidence-based guidelines and policies for coverage, ensuring that coverage decisions are based on the best available evidence.

HTAs can also be used to monitor and evaluate the effectiveness of existing coverage policies. HTAs can provide data on the impact of coverage decisions on health outcomes, cost-effectiveness, and patient access. This information can help assess the effectiveness of coverage policies and make improvements where needed.

Overall, HTAs are essential for payers to make informed and defensible policy coverage decisions. With the help of an HTA, payers can evaluate the cost-effectiveness of healthcare options, assess the clinical efficacy and safety of new technologies, and determine the long-term value of health investments.

Have you read ECRI's Top 10 Health Technology Hazards for 2023? You can download your free copy here.