3 Ways Evidence Assists Coverage Policy Determination

Three choices.jpgWith respect to health technologies, the cornerstone of any coverage policy determination requires an understanding of the following:

Does the technology work?

Is it safe?

For whom does it work?

To properly answer these questions, you can’t rely on current practice or common opinion nor can you rely on the latest publication “hot off the presses.” To truly weigh the benefits and harms of a technology compared to the standard of care, one has to undertake an exhaustive systematic search and selection of the best available evidence.

Eighty-three percent of the payer market relies on the industry-standard Hayes Rating to alert them to the best available evidence on thousands of technologies and to aid in their coverage policy determinations. But how do we arrive at our rating? Below is a description of the key methodological expertise that we at Hayes bring to our review of evidence.

Click here for our FREE webinar: “Making the Grade: Coverage Policy Challenges and the Hayes Methodology” for a chance to receive a full Hayes report.

Systematic Review

Considered the gold standard for evidence-based practice (EBP), systematic review methodology is the foundation of any Health Technology Assessment. This process involves:

  • intensive scoping of the topic
  • a tedious review of vast quantities of evidence to select the studies most likely to answer the key questions
  • a critical appraisal of the body of evidence

3D Evidence.jpgCritical appraisal is one key factor that sets us apart from other solutions. It requires extensive knowledge and understanding of study design and conduct, as well as other limiting factors such as risk of bias. In short: the process is time consuming, laborious, and incredibly resource intensive; but it is absolutely necessary in order to provide payers with unbiased evidence for their policy determinations. Hayes has the experience, skills, resources, and time to do the work for you.

Comparative Effectiveness Review

A type of systematic review is the comparative effectiveness review. While a typical systematic review focuses on the effectiveness of a single intervention, comparative effectiveness reviews assess the relative benefits and harms among a range of available treatments or interventions for a given condition. Hayes produces Comparative Effectiveness Reviews as part of our Medical Technology Directory to relieve payers of the burden of researching two similar technologies when faced with pressing coverage decisions.

But we don’t stop there.

Health Technology Assessment (HTA)

We’ve used the term “health technology” throughout. But what does it mean? While the phrase often brings to mind electronic medical/health records or some other form of health-related information technology, it actually encompasses several items, including:

·         Medical procedures

·         Drugs

·         Biologics

·         Screening tests

·         Various therapies

·         Clinical support systems

·         Alternative medicine

·         Surgeries

·         Diagnostics (i.e., MRI)

·         Organ transplants

·         Medical devices

·         Delivery systems 


A Hayes HTA takes the systematic review process mentioned above and combines it with critical policy-relevant information, including, but not limited to, regulatory information, coverage polices of other insurers, and issues of cost. Hayes continuously monitors the research and makes annual updates to our HTAs.

The above is just a glimpse of the necessary “deep dive” to bring you the most thorough analysis available. Don’t be part of the 17% that’s missing out. Join us on Wednesday, December 14 to find out why.

Topics: Health Technologies, Payers, Hayes Blog, Healthcare Evidence, Health Technology Assessments,

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