Evolving Medical Practices Web-based Subscription Service

The DHA Medical Benefit and Reimbursement Branch (MB&R) is responsible for ensuring TRICARE policy is based on current evidence, is responsive to changes in the standard of care in the United States and complies with the laws and regulations governing TRICARE. The MB&R develops program policy that allows beneficiaries to access new and emerging treatment but does not expose them to untested, unsafe, or ineffective (unproven) treatment which is specifically excluded from coverage by TRICARE regulation. Evolving Medical Practices Web-based Subscription Service is necessary to assess the safety and efficacy of new, emerging, and controversial health technologies. This requirement is established by law, that care must be medically necessary and appropriate, and proven safe and effective; this requirement is meant to assist the Government in meeting this statutory obligation. Moreover, the Evolving Medical Practices Web-based Subscription Service in question must include a proprietary rating process which is essential for DHA medical benefit determinations recommending whether a treatment is proven or unproven. Such a well-defined rating conclusion on whether the treatment is the standard of care or experimental closely aligns with TRICARE regulation.

A complete Evolving Medical Practices Web-based Subscription Service has the following elements:

1. Government  Health Technology Assessment and Genetic Testing Evaluation, Requirements - 

1.1. The contractor shall provide a comprehensive web-based library consisting of evidence-based health technology assessment (HTA) and genetic test evaluation (GTE) reports on a wide range of healthcare technologies including:  medical and surgical procedures; drugs and pharmaceuticals; diagnostic and screening tests including evaluations of genetic tests (e.g., lab developed tests); alternative therapies; and medical devices/equipment across a range of conditions and applications.  

1.2. Each HTA shall provide a clear, objective view of the science behind the health technology, clinical evidence supporting the use of the technology, the manufacturer or laboratory involved in the development of the technology, an explanation of how the technology is used in clinical practice, whether professional guidelines support use of the technology, and whether representative public and private payers reimburse for the technology.

1.3. The HTAs and GTEs shall include a proprietary rating process which assigns a score reflecting the strength and direction of the evidence for a medical technology (procedure, test, device, biologic, drug, intervention, process, or program), including:

• safety and efficacy;
• impact on health outcomes and patient management;
• indications for use; and
• patient selection criteria compared with the standard treatment/testing.

1.4. The HTAs and GTEs shall be available via a fully searchable, web-based library, consisting of a minimum of 350 HTAs and 500 GTEs, which is accessible 24 hours per day.

1.5. The contractor shall provide access to a minimum of 80 updated or new HTAs or GTEs per year.

1.6.   The contractor shall perform a literature search annually for each HTA and GTE report to update the information and flag reports requiring updating.

2. Government Research Brief with Ad hoc Report Service Requirements - 

2.1. The contractor shall maintain a Research Brief library including a minimum of 200 Briefs with approximately 60 new or updated reports produced yearly. 

2.2. The Research Briefs can be nominated by the Government to progress as an HTA or GTE to provide a proprietary rating process to weigh the strength and quality of evidence, when there is a sufficient body literature to render a rating.   

2.3. The Research Briefs are available via a fully searchable, web-based library, which is available 24 hours per day.

2.4. The Research Briefs are specific to one treatment, procedure, drug, or test applied to one diagnosis and may be specified for one patient population (e.g., adults, pediatrics, males, females or all).

2.5. The Research Briefs shall include a short, plain-language summary that indicates whether there is adequate evidence for a full assessment, as well as a conclusion regarding support for or against a technology based on a review of professional guidelines and statements. 

2.6. The Research Brief summary shall include in depth description of the medical technology.

2.7. Upon the Government’s request, the contractor shall perform an updated literature search for existing Research Briefs annually.

2.8. Upon the Government’s request, the contractor shall provide Ad hoc Research Brief reports (1 per week, and 12 expedited per contract year) that retrieve and assess literature regarding new technologies for which there is no current content  in the web-based library.

2.9. Requests for expedited Ad hoc Research Brief reports shall be delivered no later than 5 business days after delivery of request.

3.  Government Emerging Health Technology Horizon Scanning Requirements - 

3.1. The contractor shall provide reports addressing emerging and disruptive technologies with the potential for significant clinical, operational, or financial impact before they enter the market.

3.2. The report shall provide a chronology of the emerging technology through clinical trial development and the regulatory approval process.