To address the high cost, insufficient quality, and overutilization of specific medical technologies, the Washington State Health Technology Assessment Program was founded in 2007. This program produces binding decisions on which medical procedures and other technologies state-funded medical plans may cover. These evidence-based policy decisions are based on formal assessment of the medical evidence founded around the questions of technology effectiveness, safety, and cost. To date, the committee has evaluated a high proportion of radiologic technologies, with mixed decisions regarding coverage. Evidence-based policy can provide a valuable contribution to improving the quality of medical care through limiting public resources to those interventions of proven effectiveness.
The State of Washington provides health care for approximately 1 million of its 6.3 million residents. This coverage occurs through four mechanisms: (1) Medicaid; (2) the Basic Health Plan, a state-funded program that provides coverage for low-income individuals who do not meet Medicaid eligibility; (3) the Uniform Medical Plan, which is the health plan for state employees; and (4) injured workers through the Worker’s Compensation program.
Like the rest of the United States, Washington faces a health care crisis. Approximately 20% of the citizens of the state are uninsured, and 150,000 lost coverage in 2009. In addition, the state’s Basic Health Plan took a 53% budget cut in the biennium 2009-2010 as part of state efforts to solve a $4.6 billion deficit. The Basic Health Plan individual contribution rate increased by 71%, and as of 2011, there were >150,000 people on the waiting list .
The Washington State Health Technology Assessment Program (HTAP) was conceived as a partial solution to the health care crisis. The charge of the HTAP was to improve health care quality at lower cost, through the implementation of evidence-based policy for coverage decisions for specific medical procedures and technologies for state-covered individuals. The program was implemented in 2007. Central to this effort was the formation of the Health Technology Clinical Committee (HTCC), a group of 11 providers from around the state, which would determine what medical interventions would be covered under state health plans. This coverage decision was to be based on the best available evidence, following a systematic literature review, and public input.
Washington state health technology assessment program
The formal process for the HTAP consists of the identification and selection of technologies by the administrator and agency medical directors, the formulation of key questions, formal literature review and technology assessment, and decision making by the HTCC on the basis of the best available evidence. Public and stakeholder input is sought at each stage in the process, and all HTCC meetings occur in a public forum.
Technologies are identified for the HTAP because the agency’s medical directors have concerns about the safety, effectiveness, or cost-effectiveness of a technology. The selection process includes public input, and any individual can recommend a technology for consideration . Technologies considered have included diagnostic tests, interventional procedures, and behavioral interventions. For each technology, a series of key questions is formulated, which will be the clinical relevant basis for the literature review.
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Radiology decisions so far
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Table 1
Decisions of the Washington State Health Technology Clinical Committee
Technology Year Decision Conditions Upright MRI 2007 Not covered Discography 2008 Not covered CT colonography 2008 Not covered Coronary CT angiography 2008 Conditional Covered only in emergency department and inpatient settings CT calcium scoring 2009 Not covered Breast MRI 2010 Conditional Coverage in high-risk women Ultrasound in pregnancy 2010 Conditional Only two scans covered unless medically necessary Vertebroplasty 2010 Not covered PET in lymphoma 2011 Conditional Only initial scan plus additional scan for recurrence after agency approval; no surveillance scans
CT, computed tomographic; MRI, magnetic resonance imaging; PET, positron emission tomography.
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Discussion
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Conclusions
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References
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