A Home Run for Patients and Payers
“People … operate with beliefs and biases. To the extent you can eliminate both and replace them with data, you gain a clear advantage.”—Michael Lewis, Moneyball: The Art of Winning an Unfair Game
The book Moneyball tells the story of Billy Beane, the general manager of the Oakland Athletics, who collected detailed data and applied advanced statistical techniques to identify high-value baseball players.1 Beane’s data-driven, evidence-based approach to evaluating players ran counter to traditional baseball scouting techniques, which relied on subjective assessments (a batter’s swing, a pitcher’s mechanics) and time-honored performance measures (batting average, stolen bases) that correlate poorly with the ultimate outcome of winning games.
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Like traditional baseball scouts, the Centers for Medicare and Medicaid Services (CMS) often rely on subjective assessments rather than robust data to guide coverage decisions.2,3 By law, CMS must cover reasonable and necessary health services for Medicare beneficiaries.4 However, Congress did not define reasonable and necessary in the legislation that established Medicare. Further, CMS excludes consideration of cost or cost-effectiveness in coverage decisions.5 Because healthcare expenditures continue to grow, we need a more evidence-based and cost-conscious way to make coverage decisions.6
One low-cost …