New medical technologies-pharmaceuticals, medical devices, and procedures-often allow great improvements in the outcomes of medical care, but they are also widely believed to be a major cause of increasing costs. Selective adoption of new technologies, the taking on of only those technologies for which the medical benefits exceed the costs to society of developing and using them, is a crucial element in the quest to control health care costs while preserving or enhancing the quality of care.
This report focuses on adoption of innovative medical technologies by managed care organizations (MCOs). The project had two primary objectives: (1) to understand current processes MCOs use for making coverage, medical-necessity, and payment decisions involving emerging medical technologies, and how device developers and manufacturers prepare for and participate in these processes; and (2) to identify ways that private, voluntary action by the managed-care and medical-device industries individually or jointly might improve-for the benefit of society-the processes by which new medical technologies are developed, evaluated, and adopted or rejected for coverage.
We gathered empirical information from in-depth, semi-structured interviews with eight manufacturers of innovative devices and nine managed care organizations. We also collected information from representatives of manufacturers, MCOs, and the sponsors of this study-the California Goldstrike Partnership, the Economic Development Administration of the u.s. Department of Commerce, and the Health Industry Manufacturers Association (HIMA)-at a