Technology Evaluation Center Assessment Process
Framing the Key Questions. For each technology being assessed, key questions are identified that detail the critical and scientific issues to be addressed. They include:
- identification of the potential clinical indications and uses of the technology;
- identification of any alternative technologies with which the technology should be compared;
- identification of the most important health outcomes that might be affected by the technology;
- criteria for identifying and analyzing the scientific evidence for the technology.
Analysis of the Evidence. A thorough review of the body of the clinical evidence available on the effectiveness of the technology is conducted. TEC staff search all pertinent sources, sort and analyze the evidence, synthesize the results, and develop quantitative estimates of the technology's effectiveness.
The comprehensiveness of the evidence review is illustrated by the thoroughness of the literature search. These exhaustive searches include all pertinent publications and peer-reviewed unpublished sources. For emerging technologies, additional forms of research may include specialty society meeting abstracts and direct queries to investigators.
Review by an Expert Panel. Once the analysis is complete, the draft assessment is reviewed by the Blue Cross and Blue Shield Association's Medical Advisory Panel. The Panel includes nationally recognized experts in technology assessment, clinical research, and clinical practice. A majority of the membership of this Panel are independent medical experts with no affiliation to health care payers. In order to ensure broad input from physicians, appointees of the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Surgeons are members of the Panel.
The goal of the Panel is to provide an objective review of the evidence and reach a conclusion regarding the effectiveness of the technology. To accomplish this, the Panel reviews the technical work of the staff and makes judgments about the quality of the evidence and the relative weights of the potential benefits and harms.
Conflicts of Interest. All BCBSA employees are required to abide by BCBSA's Code of Business Conduct (the "Code"). The Code requires employees, among other things, to avoid actual conflicts of interest as well as situations where a conflict could appear to exist. In addition, TEC staff is required to complete on an annual basis BCBSA's Conflict of Interest Employee Questionnaire. An attorney from BCBSA's Legal and Governance Division reviews the questionnaires in accordance with the Code.
Members of the BCBSA Board of Directors are required to complete on an annual basis BCBSA's Conflict of Interest Questionnaire in accordance with BCBSA's Conflict of Interest Procedure.
MAP members are required to complete a disclosure form upon appointment to the MAP and to update it annually or when significant changes occur, whichever is sooner. The purpose of the disclosure is to assist BCBSA in responding to potential conflicts of interest. Members who perceive that a potential conflict may arise are expected to alert the Chair and/or legal counsel to the MAP prior to MAP discussion of the affected matter. In those instances where a conflict may arise, the member shall recuse himself/herself from consideration of the matter and shall refrain from voting on the matter.
It is not the responsibility of BCBSA generally or the TEC staff in particular to determine whether a study investigator has a conflict of interest. However, in the event that the TEC staff discovers that a study investigator, whose conclusions the TEC staff relied upon in preparing a draft assessment, had or may have had a conflict of interest, then the TEC staff will notify the MAP of the situation and the MAP shall decide how to proceed with the assessment.
