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Coverage Guidances

 

To find a coverage guidance, visit our Completed Topics page, or our Topics Under Developement page.
  

In Oregon's Action Plan for Health, the Oregon Health Policy Board calls for the development of an initial set of 10 Oregon-based best practice guidelines and standards. The intent is to build upon the high standards of evidence evaluation used in the development of guidelines and health technology assessments by HERC and other trusted sources, creating a process that will allow evidence-based practices to be applied rapidly and uniformly across public and private settings to reduce unnecessary care and drive down costs.

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HERC Coverage Guidance Process

To view the steps of each phase of the Coverage Guidance process, click on the tabs below:

  1. Staff Research
    Staff conducts research to identify new topics based on reports from trusted resources.

  2. Prioritize Topics
    Based on staff recommendations, HERC to prioritize topics and assign to the Evidence-based Guidelines Subcommittee (EbGS) or the Health Technology Assessment Subcommittee (HTAS).

    Follow topic prioritization in HERC meeting materials.

  3. Assessment
    Notice is sent to stakeholders at least 30 days prior to initial review by either the EBGS or HTAS.

  4. Announcement
    Notice is sent to stakeholders at least 30 days prior to initial review by either the EBGS or HTAS.
    Receive notices by e-Subscribing to the HERC list.

  5. Prepare Initial Draft
    Staff develops draft coverage guidance, with input from appointed ad hoc experts if necessary.
  6. Initial draft is posted to the EbGS or HTAS meetings materials page at least 7 days prior to initial review.

  1. Initial Review
    The subcommittee reviews the initial draft at a public meeting and votes to post the guidance for a public comment period. The subcommittee can also opt to revise the draft, request additional information, or table to discuss – in which case the initial draft would require another review before moving to public comment.

    This is a public meeting. Oral comment is accepted at public meetings but may be limited to 5 minutes per topic shared among those who comment.

  2. Public Comment
    The draft guidance approved by the subcommittee is posted online for 30 days of public comment. Policies: HERC Criteria for Topic Review on the Placement of Services on the Prioritized List and HERC Policy on Acceptance of Testimony and Guidelines for Speakers & Presenters.

    *Written comments can be submitted to HERC.info@state.or.us. Comments are limited to 1000 words not including any citations or article.

  3. Staff Research
    Based on public comment, staff research, draft responses and propose revisions to the draft guidance.

  4. Review Public Comment & Refer to Value-based Benefits Subcommittee
    At a public meeting, the subcommittee reviews public comments and staff responses. The subcommittee may approve the coverage guidance and refer it to the Value-based Benefits Subcommittee, revise the coverage guidance, or request additional staff research. If changes are made, the subcommittee may repost the draft coverage guidance for an additional 21-day public comment period, in which case the draft guidance would return to step 3 above.

    * This is a public meeting.

  1. VbBS Review
    At a public meeting, the VbBS reviews the draft guidance. They may recommend revisions for implementation and prioritization considerations. If changes are significant, the draft may be posted for an additional 21-day comment period and return to the referring subcommittee. Once it has reached a decision, the VbBS refers the draft coverage guidance, and associated changes to the Prioritized List of Health Services, to the HERC..

    * This is a public meeting.

  2. HERC Review
    At a public meeting, HERC considers the guidance and any associated Prioritized List changes for final approval.

    * This is a public meeting.
  1. Staff Monitoring
    HERC reviews the need to update each approved guidance once every two years. If a topic is determined to need review, the coverage guidance process begins again, at phase 1, with prioritization. Reviews may be initiated at any time, and may be requested by interested stakeholders. Reviews will be initiated if staff finds new evidence not previously considered, or information indicating misinterpretation of previously available evidence.


Methodology

The HERC develops recommendations by using the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. GRADE is a transparent and structured process for developing and presenting evidence and for carrying out the steps involved in developing recommendations. There are four elements that determine the strength of a recommendation, as listed in the table below. The HERC reviews the evidence and makes an assessment of each element, which in turn is used to develop the recommendations presented in the coverage guidance box. Balance between desirable and undesirable effects, and quality of evidence, are derived from the evidence presented in this document, while estimated relative costs, values and preferences are assessments of the HERC members.

For more about the GRADE methodology, see the GRADE working group web site, and this presentation by HERC member Wiley Chan from the May, 2013 meeting. In addition to using the GRADE methodology, the Commission has developed its own Guidance Development Framework.

Evidence-based Policy Presentation

This presentation, What Is Evidence-informed Health Policymaking, by Martha Gerrity from the Center for Evidence-based Policy (CEbP) at Oregon Health and Sciences University (OHSU), discusses the use of evidence for making health policy decisions. Methods of analyzing evidence (e.g., systematic reviews, randomized controlled trials, observational studies) to determine its quality are described. Also discussed are key questions which should be asked when reviewing evidence.

This presentation was made to the Health Technology Assessment Subcommittee of the HERC on March 22, 2012. This video is being posted for use by the HERC and its subcommittees as well others who might benefit from a primer on this topic.