It's unlikely that Americans have ever been more tuned-in to discussions on what it means to make data-driven, medically sound health care decisions. As the Corona Virus dominates the world's attention, a new white paper outlines why it matters that evidence-based guidelines are followed in health care—especially to those who paying for that care.

The new paper, "What Employers Need to Know about Evidence-Based Medicine and Clinical Guidelines," was released by Connections Health Care Cost Containment, a consulting firm that blends expertise from both the clinical and financial side of health care management.

According to the report, providers are still lagging behind in using the best evidence-based practices when it comes to delivering health care. "While evidence-based medicine (EBM) is the gold standard taught to all clinicians and is widely accepted as important to drive superior outcomes, day to day decision-making in health care is slow to evolve from 'opinion based' or 'experience-based' to those based on sound scientific evidence," the report says in its introduction.

Not only better health, but lower costs

The case for using evidence-based tools such as clinical practice guidelines (CPGs) has a wealth of statistics to back it up. The report noted that a recent study estimated that if providers in the United States followed six heart failure guideline recommendations, approximately 68,000 deaths a year could be prevented.

The report also discussed data from the United States' Agency for Healthcare Research and Quality (AHRQ) showing that between 2010 and 2014, there was a seventeen percent decline in hospital-acquired conditions (HACs) as a result of efforts to improve quality of care and reduce adverse events. This emphasis on quality is estimated to have saved $19.8 billion in health care costs over a four-year period—underlining why employers and health insurance purchasers have such a stake in evidence-based medicine

However, the researchers said, much more can be done. "While lives have been saved and costs dramatically lowered through the adherence to CPGs, the United states is not currently achieving anything close to our maximum potential," the Connections report said.

What is blocking adherence to evidence-based medicine?

The Connections report points to two areas that holding up better compliance with CPGs. One is simple human nature: physicians and other providers are often more likely to trust their training and experience than new guidelines, even if the evidence supports those guidelines.

"Many physicians consider CPGs as inhibiting their professional autonomy and flexibility, as well as depersonalizing the physician-patient relationship," the report said. "They may not trust their ability to implement and stay up to date due to time and limited resources."

The report said payers have the ability to push for better adherence to CPGs and outlined several strategies that employers can used to improve quality and reduce costs. These strategies include:

Adjusting health plan language: Language in health plan contracts that links "medical necessity" or "usual or customary care" gives providers broad latitude for making medical decisions. "Employers should consider stronger health plan language such as, "payment will be considered for services that are based on Evidence-Based Medicine Guidelines," the report said.
Empowering and educating health plan members: The report calls for empowering patients as partners in health care quality efforts. "Educate health plan members to evidenced-based medicine and its importance in making sound health care-related decisions," the report said. It suggested educational efforts such as a "Get with the Guidelines" campaign.
Next-generation medical management: The report also promoted what it called Next Generation Medical Management, which it said would ensure that the right patients gets the right care at the right time, for the right price.

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The argument for evidence-based medicine and why employers should care

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