Placement: Health Policy Institute, Center on Health Insurance Reforms, Georgetown University
Mentor: Kevin Lucia, J.D. (Research Fellow and Project Director, Center on Health Insurance Reforms, Georgetown University)
Co-Mentors: Justin Giovannelli, J.D. (Associate Research Professor and Project Director, Center on Health Insurance Reforms, Georgetown University) and Joe V. Selby, M.D. (Executive Director, Patient-Centered Outcomes Research Institute)
Project Title: Determining Covered Benefits: Exploring Drivers and Processes for Decision-making and Constructing a Roadmap for Future Good Practice
Dimitra Panteli, M.D., M.Sc.P.H., Dr.P.H., is a 2016–17 German Harkness Fellow in Health Care Policy and Practice. She is currently a research fellow at the Department of Health Care Management at Berlin University of Technology, a role she has held for the past six years. Her work focuses on evidence- based decision-making in health care, primarily health technology assessment, and health systems research, most recently on pharmaceutical regulation and quality assurance. She is also a collaborator of the European Observatory on Health Systems and Policies, where she serves as editor for the Health Systems in Transition series and contributes to various thematic studies as well as active knowledge-brokering. Her work has led to collaborations with diverse stakeholders, including Ministries of Health, regulatory institutions, insurers, national institutes for public health and quality assurance, health technology assessment agencies, and professional associations. She is a member of the extended Board of the German Network on Evidence-Based Medicine and the German Society for Technology Assessment in Health Care. Panteli received her doctorate in public health from Berlin University of Technology, her M.Sc.P.H. from the Charité Medical University in Berlin (as a scholar of the German Academic Exchange Service) and her medical degree from the Aristotle University of Thessaloniki in Greece.
Project Abstract:
This project aims to understand how covered benefits are determined in the post-ACA reality by exploring drivers and processes for decision-making at different levels and their implications for consumers. It further seeks to clarify the role of scientific evidence in this context and gain insight into the views of different stakeholders regarding the value of covered benefits. Ensuring that appropriate, effective services are covered for citizens across the country is not only important from the perspectives of equity and quality of care. It also has the potential to minimize the waste of resources, mitigating costs for the health system in general and consumers in particular. However, in the context of constrained resources, third-party payers may perceive the (relative) value of potential benefits differently from patients and system regulator. This research will focus on the non-group and small-group insurance market and draw relevant comparisons to publicly funded programs. Specifically, it will explore the coverage of habilitative services (including devices) and the composition and working process of Pharmacy and Therapeutics (P&T) committees in a selected number of states. It will combine the analysis of publicly available documents (e.g. benchmark plan summaries, P&T committee and formulary information, institutional process guides, etc.), stakeholder interviews with regulators, insurers and patient advocates, and observation of existing evidence-based processes. Furthermore, it will contextualize findings with a comparison to selected health systems in Europe.
