Evidence-based medicine: employers also have a role to play
Although employers are often left out of discussions about making research more relevant to clinical practice, they can help improve the use of evidence-based care.
The role of employers in helping employees find the best evidence-based medical treatments is the subject of a new report released last week by the Center for Workforce Health and Performance (CWHP). Evidence-based research is one of the pillars of medical practice in the United States, yet there are many cases where consumers get incorrect or incomplete information.
The new report, “The Employers Role in Using Research-Based Health Care Evidence” finds that although employers are often left out of the discussion of how to make research more relevant to clinical practice, they can help improve the use of evidence-based care.
“There’s little doubt about the value of research-based evidence in making health and health care decisions. Yet passage from research setting to provider’s office, let alone to the employment setting, is typically neither timely nor guaranteed,” said CWHP president and CEO Kimberly Jinnett, MSPH, PhD, who co-authored the study. “The employment setting remains an undervalued investment opportunity for employee health improvement. Given employers’ relationships with health plans, providers, and employees, they can play a significant role in making this process more effective.”
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The authors identify a number of issues and barriers that affect the ability of evidence-based research to inform health care of employees on company-sponsored plans:
1. Claims and cost. the report suggests that many employer-based plans pay much more attention to cost and claims data than to medical literature. For example, costs for depression treatment are often not a top expense when looking only at claims data, but when lost work time and other issues are considered, its impact is much more pronounced. Likewise, a specific drug might be the most effective in treating a disease, but it may not be included in a plan’s formulary. These situations, where short-term data outweighs medical literature, may be harmful to the company in the long run.
The cost vs. data conflict can cause tensions between health insurance carriers and employers, the study notes. Although larger employers with in-house clinics do better on integrating clinical data into their plans, there still can be resistance on the part of insurance carriers to new treatments, even if the data show them to be effective. The study suggests that employers use more complete health analysis of their employees, including health risk assessments, which can point out gaps in care. Better data on the population will lead to better use evidence-based medicine, the report said.
2. Employee and provider buy-in. Some of the problem may be at point-of care, the study notes. To address this, incentives can be written into contracts with providers to regarding use of research-based evidence in care. Employers and carriers can work together to provide trusted resources of information to employees. The study also singles out high-deductible health plans as problematic. “High-deductible health plans are often just risk/cost shifting to employees with the likelihood that employees will become less compliant with evidence-based care,” said one of the researchers in the study. “It also assumes that an employee can take a totally rational and long-term approach to their own investments in health, which they don’t or can’t.”
3. Support for employees. Several of those quoted in the study emphasized the need to support employees in seeking the best evidence-based care. If drugs or treatment are denied by a provider, some employers intervene directly. Educating employees about the best care for their conditions can help them spot problems or barriers in their own care plans. And providing onsite clinics and wellness programs can also improve the use of evidence-based medicine, the study found.
The report suggests employers take a more holistic view of health care, along with finding resources and partners to help companies work toward the goal of more-informed health care. “In partnership, employers, their solutions partners, evaluators, and the larger research community can better fit solutions to problems by taking a broader perspective,” the study recommends. “This should result in better evidence and better use of that evidence.”