This presentation was made at the Technology and Outcomes Assessment Workshop of FRESH-Thinking, held in February 2007. Funded by the Robert Wood Johnson Foundation, the FRESH-Thinking project addresses operational, financing and regulatory issues that are generic to any and all health care reform plans. The project aims at clarifying long-term issues and proposing solutions to the implementation of comprehensive health care reform. 

This paper noted that previous and current technology assessment in the United States is done poorly for four main reasons:

1. Poor coordination, technical standards and uneven quality.
2. Weak legitimacy since many payers pay for the assessments, and poor transparency to give public confidence in objectivity of the results.
3. Limited usefulness since assessments take too long and, more important, they fail to integrate cost into assessments. 
4. Poor or no integration of technology assessments with coverage decisions.

Examples of technology assessment, especially the National Institute for Clinical Excellence (NICE) in the United Kingdom were examined and shown to have important characteristics for a successful technology assessment initiative in the United States.

The study of past and existing efforts in the United States and experiences in foreign countries lead to five key recommendations:

• Define common nomenclature and classification. Pearson offered a comparative clinical effectiveness matrix as an example.
• Enhance transparency of the assessment process by engaging all stakeholders including technology manufacturers, physicians, payers, patient advocates, etc.
• Integrate costs into technology assessment. This is key for determining the value of a new technology.
• Integrate technology assessment into benefit design, mainly by having higher co-payments for technologies that are less effective or more costly.