Mission: The purpose of the New England Comparative Effectiveness Public Advisory Council (CEPAC) is to aid patients, physicians and policymakers in the region in the application and use of comparative effectiveness information to improve the quality and value of healthcare in New England.  In partnership with the Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment, CEPAC is tasked with aiding in the adaptation and implementation of comparative effectiveness information.  The mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process.  CEPAC is an independent body of 18 members, composed of clinicians and patient or public representatives from each New England state with skills in the interpretation and application of medical evidence in health care delivery. Representatives of state public health programs and of regional private payers are included as ex-officio members of CEPAC. 

Process: CEPAC convenes twice annually to review timely comparative effectiveness research, comment on its relevance for the six New England states; and aid in the translation and implementation of the evidence in policy and practice throughout the region. During these public meetings, CEPAC is presented with an evidence review and public comments; deliberates and votes on key questions related to comparative effectiveness and value; and discusses and debates the implications of the council votes with a panel of patient, payer, and clinical stakeholders, highlighting key avenues for implementation of the evidence. The evidence reviews that form the foundation of CEPAC meetings are based on existing comparative effectiveness reviews that are updated and supplemented by ICER with economic and regional-specific analyses to make the information more actionable for decision-makers. The deliberations and decisions of CEPAC are conducted in a public forum to ensure transparency and accountability to all stakeholders throughout the process. 

Impact: 
Coverage policy: CEPAC results have been used by regional insurers to inform medical policy.  Following the December 2011 CEPAC meeting on treatment-resistant depression, the Medicare Administrative Contractor for most of New England, NHIC, Corp, issued a final local coverage decision granting first-in-the-nation Medicare coverage for repetitive transcranial magnetic stimulation (rTMS), citing the votes taken by CEPAC as part of its rationale for coverage. Following the NHIC Corp decision, four additional payers have reversed non-coverage policies for rTMS, including Anthem Blue Cross.  Following the December 2012 meeting on obstructive sleep apnea, regional payers have cited plans to adjust coverage for sleep management to encourage the use of home sleep testing based on findings in the CEPAC report that home sleep testing offers comparable benefit to in-lab sleep testing for lower cost.  

Stakeholder collaboration: Hospitals both regionally and nationally are collaborating to develop patient registries with standardized collection methods for tracking long-term outcomes for patients undergoing rTMS or electroconvulsive therapy to help inform coverage with evidence development initiatives. 

Physician and patient education: CEPAC reports have been translated into Action Guides that distill key evidence-based steps for patients and physicians to use when making healthcare decisions. These Action Guides have been incorporated as a resource on major patient education and support websites and well as through national and regional clinical specialty society websites and literature.