Discuss the technological assessment process carried out by health insurance plans.
What will be an ideal response?
• When a new technology is developed, the developers and/or the clinicians who want to utilize the technology approach the health insurance organization to request inclusion on the list of reimbursable services. Once this request is received, the insurance organization usually asks for a formal assessment of the technology. The request for assessment focuses on the effectiveness of the technology and usually does not include any reference to cost or its price to the insurance organization.
• Using the California Technology Assessment Forum as a model example, university faculty members carry out the initial review of scientific evidence and peer-reviewed scientific literature. After they finish their review of the evidence, they file a formal report with a scientific advisory panel composed of technology experts drawn jointly from academia and the professional community. After open public hearings, the scientific advisory committee decides whether the technology has been proven to be effective and then reports its opinion to the health insurance plan. The plan then makes its own coverage decision, utilizing the background review and opinion filed by the advisory committee. Decisions regarding level of payment for the technology are handled within the health insurance organization and are not included in the activities of the independent technology assessment process or organization.
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