Mission: The New England Comparative Effectiveness Public Advisory Council (CEPAC) is an independent body of clinicians, methodologists, and public representatives from all six New England states who convene at public meetings to review analyses of the evidence on medical tests, treatments, and delivery system interventions. CEPAC is a core program of the Institute for Clinical Economic Review (ICER), an independent non-profit that evaluates and interprets evidence, models economic impact, and provides guidance on how to apply this information in the real world.
CEPAC’s mission is to aid patients, physicians, and policymakers in New England in the application and use of the most up-to-date information to improve the quality and value of health care in the region through three mechanisms:
1) Providing all health care decision makers with independent, rigorous evaluation of the strength of evidence behind high-impact health care interventions
2) Producing robust economic models on the potential impact of new therapies
3) Offering evidence-based recommendations related to improving practice and policy. These recommendations are intended to inform provider quality improvement activities, enrich patient information materials, and support decisions surrounding coverage policies and benefits.
Ultimately, CEPAC creates an open, transparent process through which payers, providers, and the public can work together to improve the application of evidence throughout the health care system.
Structure and Process: CEPAC began as a program supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) and continues with support from a consortium of New England state Medicaid programs, regional private payers, integrated provider groups, and public advocacy organizations, all of whom serve on CEPAC’s Advisory Board. The Advisory Board offers input into the selection of topics for CEPAC meetings and shares strategies for applying the results of CEPAC meetings throughout New England.
Currently, CEPAC is comprised of 16 individual members including clinicians, methodologists, and patient and/or public members from across New England. Representatives of public and private payers participate on the council as ex-officio members. Council members are not necessarily subject matter experts in each of the topics they review; rather, they are skilled in interpreting and applying medical evidence to health care policy and practice across a range of topics, allowing for an objective interpretation of the evidence.
CEPAC Public Meetings
CEPAC public meetings are held three times annually. Each meeting is based on a report developed by ICER. Reports aim to synthesize available evidence on comparative clinical effectiveness, analyze cost-effectiveness and budget impact, and summarize relevant coverage policies and professional guidelines. Each meeting has three main components and is typically structured as follows:
1) Evidence review: Meetings begin with a review of the current evidence and the results of economic modeling included in CEPAC’s report.
2) Council Voting: Following the evidence review, CEPAC deliberates and votes on comparative clinical effectiveness and value based on available evidence.
3) Policy Roundtable: Meetings conclude with a policy roundtable session, during which the Council is joined by a panel of patient, payer, and clinical stakeholder representatives with expertise in the topic area. The intent of each panel is to discuss how evidence can best be applied to policy and practice throughout New England.
CEPAC’s report and meeting process allows several opportunities for stakeholder and public input. Stakeholders and members of the public are encouraged to comment on the initial scope of the report as well as the publicly available draft version of the report, and are provided an opportunity to make oral remarks during the public meeting. CEPAC proceedings are conducted in a public forum to ensure transparency and accountability to all stakeholders throughout the process. More information about CEPAC and the public comment process is available on the program’s website: cepac.icer-review.org.
Impact: To date, CEPAC has helped catalyze several notable changes in medical practice and policy. Examples of CEPAC’s impact include:
- Results from CEPAC’s report on Nonpharmacologic Interventions for Treatment-Resistant Depression were used by regional and national payers, including the Medicare Administrative Contractor the majority of New England states, to expand coverage for transcranial magnetic stimulation (TMS).
- CEPAC’s report on Integrating Behavioral Health into Primary Care was cited by CMS and has been featured on the AHRQ Integration Academy’s website, a national clearinghouse for integration resources.
- CEPAC’s report on Management of Patients with Opioid Dependence has been referenced by payers and policymakers throughout New England. In the months following the report 16 major health plans in Massachusetts began covering Methadone for opioid addiction treatment.
CEPAC reports and meetings have also impacted health care by fostering the development of clinical registries to gather additional evidence on emerging treatments; supporting state policy on health care workforce development; and providing material used by specialty societies and patient organizations for education of their members. In the four years since its inception, CEPAC has demonstrated a distinctive ability to engage senior regional leaders and facilitate the application of evidence to change practice and medical policies to improve quality and reduce costs.