With some very overt participation in comparative effectiveness research, one may have expected representatives from traditional large health care organizations or pharmacy benefit managers to be appointed to the Patient-Centered Outcomes Research Institute first board of governors. However, they were left off the board, announced Sept. 23.

Regional health plans did get some representation: Sharon Levine, associate executive director for the Permanente Medical Group of Northern California, a multi-specialty group practice and Kerry Barnett, executive VP of corporate services and chief legal officer of the Regence Group, an affiliation of four not-for-profit Blue Cross/Blue Shield plans, based in Portland, Ore.

But no representative from a private health insurer with national coverage was appointed to the board.

In addition, the largest national payer, CMS, also has no representation on the PCORI board. The federal government representatives included the directors of the Agency for Healthcare Research and Quality and the National Institutes of Health, or their designees.

But perhaps also notably, one nationwide group that does provide health care services and has what it views as lengthy expertise in comparative effectiveness research is represented: the Department of Veterans Affairs. The VA provides health services to 5.5 million veterans at 153 medical centers and other facilities. Suggesting it sees itself as a major player in the field, the VA held a conference a year ago posing the question: "What can the health care system learn from 30 years of comparative effectiveness research at the VA?" It will be represented on the board by Robert Jesse, principal deputy undersecretary for health.

The board's composition raised an eyebrow with Tanisha Corino, senior VP at consultancy Avalere Health.

"What's interesting is that [traditional large health plans and PBMs] have been very early advocates for CER," Corino said in an interview. "For them not to have a seat at the table at this point, to me, is pretty surprising."

Large insurers, in some cases, have been at the forefront of the comparative effectiveness research scene. WellPoint has been an advocate for CER, most recently signaling how it will evaluate comparative evidence in the course of making coverage decisions (Also see "WellPoint's CER Guide Describes How It Will Determine Usefulness Of Studies" - Pink Sheet, 24 May, 2010.). In the past, as momentum for CER was starting to build in the pubic consciousness, the Blue Cross Blue Shield Association offered to commit to funding a public-private institute to conduct CER (Also see "Comparative Effectiveness Funded By Public-Private Trust Proposed In House" - Pink Sheet, 14 May, 2007.).

Likewise, the PBM space is currently active in the comparative effectiveness arena, with Medco taking a public lead in its activities (Also see "Antipsychotic Drugs Are Medco's New Personalized Medicine Target" - Pink Sheet, 6 September, 2010.).

Corino suggested this could be a way to reinforce the institute's patient-centered focus.

"The absence of CMS or major health plan at the table may be a way of signaling that this is really going to be about patients and practicing physicians," Corino said.

Dan Leonard, president of the National Pharmaceutical Council, did not see the lack of PBM or large health plan presence as a point of interest. "That did not jump out at me, actually," he said in an interview

Rather, Leonard focused on the positives of the makeup of the board when talking about his initial reaction to the appointments.

"I'm impressed by the geographic diversity of the group," he said. "This is not really a Washington-centric group of folks. … There are actually very few names on this list who are Washington folks who would be well-known in Washington circles."

He added that the group of appointees met the legislative intent of a stakeholder board that draws "experts from multiple disciplines and diverse backgrounds, and I think they've clearly got that from the names on this list."

As expected, the pharmaceutical industry has a lone representative on the board – Pfizer Chief Medical Officer and Senior VP Freda Lewis-Hall. She was among the nominees from both the Biotechnology Industry Organization and the Pharmaceutical Research and Manufacturers of America (Also see "Pfizer's Lewis-Hall To Represent Pharma Interests On PCORI Board" - Pink Sheet, 23 September, 2010.).

Early Emphasis On Cardiology?

The other aspect of the PCORI appointments that Corino found interesting was the presence of a substantial number of cardiology experts (see chart).

Of the 19 appointees, cardiology experience is prominent among four of the board members, including Debra Barksdale, associate professor at the University of North Carolina at Chapel Hill School of Nursing; Harlan Krumholz, the Harold H. Hines Jr. professor of medicine and epidemiology and public health at Yale University School of Medicine; Richard Kuntz, senior VP and chief scientific officer at Medtronic; and Harlan Weisman, chief science and technology officer, medical devices and diagnostics, at Johnson & Johnson.

"There are a lot of very prominent cardiology experts around that table," Corino observed. "That's not to say that the priorities are going to be leaning towards cardiology, but anybody who has expertise around that table is going to bring their own history and what they know, where the research is and it isn't. I wouldn't be surprised if you see a lot of focus on some of the [Institute of Medicine] priority topics around cardiology come to the top of the interests of the PCORI board." IoM's priority list was issued in June 2009 (Also see "Comparative Effectiveness Infrastructure Is Priority, Federal Advisors Say" - Pink Sheet, 6 July, 2009.).

By Gregory Twachtman

Large Payers, Including CMS, PBMs, Mostly Absent From PCORI Board

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