Evidence-Based Coverage Policy

The principles underlying evidence-based coverage policy and how they are applied by two major programs are discussed, the Technology Evaluation Center of the Blue Cross Blue Shield Association and the Medicare Coverage Advisory Committee.

Abstract

Many health plans apply evidence-based approaches to coverage decisions. The foundation of such approaches is the systematic review of information about the effectiveness of medical interventions. This paper discusses the principles underlying evidence-based coverage policy and how they are applied by two major programs: the Technology Evaluation Center of the Blue Cross Blue Shield Association and the Medicare Coverage Advisory Committee. Although such policies likely have limited effects on spending, they can help to direct medical resources toward effective care.