Dr. Eric Berman, Executive Medical Director for Medical Policy & Clinical Innovation

Sometimes it’s useful to be reminded of what we don’t know.

I had that thought last month while reading an article in The New York Times about a recent study in the British Medical Journal (BMJ). The BMJ analysis examined the scientific evidence behind thousands of medical treatments in common use today. Here’s what it found:
In some cases, the latter treatments were put into practice long before evidence-based standards were established, and they simply have never been thoroughly tested. In other cases, experimental treatments may come into practice based on promising preliminary reports, which may or may not be borne out through more extensive study.

​Either way, the BMJ analysis is a useful reminder of why we at Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) have such rigorous medical policies governing the treatments that can be prescribed for our members.

For example, our medical policy team, made up of licensed physicians, nurses and other health care professionals, continually reviews the scientific literature for the latest information about the safety and effectiveness of new and existing medical treatments, procedures and drugs. And our Clinical Policy Committee – comprising Horizon medical experts and practicing physicians in New Jersey – meets monthly to review and update the more than 720 detailed medical policies that guide our decision-making (for more information about our medical policies, see “Getting the Most of Your Coverage: Seven Things to Know About Medical Policies”).

What the BMJ study also tells us is that patients who raise questions about their treatment deserve to understand what’s known – and what may not be known – about the medical care being prescribed. Those conversations should not be avoided, they should be encouraged. In the end, improving the quality and affordability of health care can only occur when all of us involved – doctors, patients, and insurers – work together to build evidence-based models of care that takes into account the relevant scientific evidence, clinical judgement and patient preferences.

Click here to read the full New York Times article.