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Addressing Children’s Behavioral Health Through School Telehealth Programs

August 25, 2021
2:44 pm

Children are the future, however what does the future hold for our children? The CDC estimates that as many as one out of five children experience a mental disorder in a given year and mental health has become an important public health issue. The Wall Street Journal recently highlighted the rising rates of depression and anxiety resulting from digital addiction, which worsened exponentially during quarantine. The author stated that the digital drug of choice is the equivalent of the hypodermic needle for a wired generation.

Providing behavioral health services to children, particularly those living in rural communities, is challenging. However, a partnership between Blessing Health System and Teladoc Health has led to a pilot telehealth program in Missouri for a school district of 11,000 students. As a hybrid model, school nurses are able to connect with the local health system and create appropriate treatment plans based on the acuity of each situation. The school system has already seen the benefit of virtual health technology through decreased absences.

There were many factors in ensuring this pilot was effective. The school district’s Wi-Fi needed to be upgraded to guarantee reliability with the technology. School counselors were included in the program to integrate the behavioral health aspect. Parents were educated about the conveniences of telehealth and how register their children. The program now intends to expand even more into behavioral health and into more schools.

This is a prime example of how effective partnerships between health systems, technology companies and school systems can be for local communities. As children return to in-person learning, and potential long-term effects of quarantine appear, programs such as this one weave a safety net and keep parents, teachers and healthcare providers in sync.

Why We Don’t Need and Shouldn’t Want a Public Option

August 11, 2021
2:07 pm

Earlier this year, Senator Patty Murray (D-WA), the chair of the Senate Health, Education, Labor and Pensions Committee, and Congressman Frank Pallone (D-NJ), chairman of the House Energy and Commerce Committee, announced their intent to introduce legislation creating a government-run public health insurance option to compete with private insurers and asked interested organizations to offer perspectives on the issue.  In the Healthcare Leadership Council’s (HLC) written response, I told the lawmakers that a public option “is an unnecessary and potentially damaging policy alternative” that “creates a distorted playing field on which private health plans could not adequately compete.”

But this requires some elaboration.

When Congress debated the Affordable Care Act in 2010, heavy Democratic majorities in the Senate and House rejected the notion of a public option.  Today, the country and Congress are more evenly divided and there is even less reason to make such a significant change to our health coverage system.  We are enjoying exceptional stability in which there has been minimal change in monthly premiums in the individual health insurance market for three consecutive years.  And we shouldn’t forget that 160 million Americans have health insurance provided by their employers, a benefit worth $800 billion annually in personal value to American families.  While there is widespread agreement that we need to continue working toward even greater coverage affordability and accessibility, a public option creates more problems than it solves.

In the HLC response to Senator Murray and Congressman Pallone, I detailed several other likely consequences that would occur if a public option was created:

  • A public option offering comparably low, taxpayer-subsidized premiums and reduced out-of-pocket costs would create a scenario in which private plans could not reasonably compete, creating political pressure to make the public option available to all consumers. One study projects this would lead to 123 million people enrolled in the government-run program by 2025, completely destabilizing a private insurance market that – according to a November 2020 Gallup poll – Americans still prefer.
  • Patients would likely see decreased access to healthcare providers should a public option come into existence.  When Oregon was deliberating the creation of a state public option, an analysis written by President Biden’s administrator of the Centers for Medicare and Medicaid Services (when she was managing director of a health policy analysis firm) found that the public option would likely reduce provider payment rates in order to achieve lower monthly premiums for enrollees.  This would be devastating for hospitals, particularly for smaller rural providers.
  • If a goal of the public option is to reduce the number of uninsured in the country, it’s likely to fail.  A KNG Health Consulting analysis of the public option concept found that roughly 90 percent of enrollees would be comprised of individuals who were already covered by employers or a commercial non-group plan.  In other words, it would simply erode the already-successful private marketplaces.

As I told the lawmakers, there are better, less disruptive, more patient-centered policy alternatives.  Among them, use premium tax credits and cost-sharing protections to strengthen access to coverage and care for lower-income consumers.  Establish a permanent health reinsurance program to support the cost of care for those with significant medical needs.  Encourage innovation in state Medicaid programs to emphasize whole person and value-based care as well as care coordination.

In other words, we can have a better health coverage system that serves the needs of every American, but the public option concept would make quality healthcare less, not more, accessible.

Looking at Physician Training Through a Wide(r) Angle Lens

July 27, 2021
10:49 pm

Historically medical school curricula have, for the most part, revolved around the actual practice of medicine and not the business aspects that will also affect a physician’s work life and financial viability. Independent physicians, of course, need an understanding of how to make their practices sustainable successes, and even doctors in large group practices or institutional settings can benefit from the skills that create a pathway to organizational leadership. Many physicians are now returning to school to earn MBAs. This is becoming an increasingly-seen trend across the nation since MBA programs help further physician knowledge in key areas such as finance, accounting, and microeconomics.

Many medical schools are beginning to incorporate business concepts and training into their degree programs. For instance, the Mayo Clinic and Arizona State University (Alliance for Health Care) developed a dual MD/MBA program. This program is specifically structured to help train physicians in the intellectual disciplines and practices of medicine and management. For the future of healthcare, physicians should not only be seen as doctors who treat patients, “but also economists, administrators, and problem solvers working toward improving patient care.” This unique MD/MBA program is deeply rooted in helping individuals become future physician leaders. Likewise, the Cleveland Clinic and Western Reverse University have joined forces to create a healthcare master’s degree program in response to the evolving healthcare field and the higher volume of clinical doctors graduating from MBA programs. The curriculum includes instruction and practical experience in the general management fields of leadership, strategy and innovation.

As healthcare becomes increasingly integrated, medicine and business are moving toward a hand-in-hand relationship. The business side of healthcare offers new and innovative solutions to better manage and improve organizational operations. At the same time, these programs offer insights on how to better provide cost-efficient care to patients. As healthcare organizations recognize the need for business sense among clinicians of medicine, the number of specialized degree programs combining the two will grow. This evolution within the healthcare industry can lead to improvements in processes alongside quality of care.

Blockchain Technology and its Current Status in the Healthcare Industry

July 15, 2021
11:12 am

Blockchain technology is an anticipated medium in the healthcare industry because of its ability to secure patient data, streamline care and prevent costly mistakes. This trusted technology is a database which stores blocks of digital assets that are not copied or transferred, but distributed, which preserves the integrity of the document. With this type of security, people can feel more comfortable with how their records and personal identity information are shared and secured.

While blockchain is currently used as a way to preserve data integrity and transparency, there is exploration into utilizing it to create a network that increases ways to manage and exchange skills-based credentials. Healthcare leaders have shown interest in its potential to improve transparency and interoperability in care networks. Some organizations, such as Aetna, Cleveland Clinic and Healthcare Service Corp. plan to use blockchain to decrease administrative costs correlated with transferring data between payers and providers. Avaneer Health, a utility network created by Aetna and Healthcare Service Corp., along with IBM and PNC Bank, uses blockchain to ease the transferability of data among payers and providers. The healthcare industry is experiencing challenges in regard to unnecessary costs and inefficient payment processing and Avaneer Health’s partner companies hope it can find a solution to those challenges.

Change Healthcare, a leading healthcare technology company that focuses on simplifying and improving data services and enhancing clinical decision-making, has invested significantly in blockchain. Its first incorporation of this technology was to speed claims processing. The company has now expanded their efforts to improve healthcare payments and revenue cycle management processes. In 2017, Change Healthcare forged the use of enterprise-scale blockchain technology with Intelligent Healthcare Network™ and today, processes up to 50 million transactions daily. Through concerted efforts, they have been able to increase efficiency, which in turn lowers the cost of administering claims. A year later, Change Healthcare collaborated with TIBCO to create healthcare’s first smart contract system.

Blockchain technology is still evolving–it can be costly for industries and it takes time to work out complications to adapt to the different hospital needs–but the advantages and security it provides broadens its appeal in multiple sectors. Its impact is expected to increase exponentially in the next few years.

The Innovation-Competition-Affordability Connection and its Importance to Patients

June 15, 2021
12:49 pm

One of the biggest headlines in healthcare this month occurred when the Food and Drug Administration gave approval to a new treatment for Alzheimer’s disease developed by Biogen. This is a development that brought hope to the millions of individuals and their loved ones who have or will have a terrible and complex disease that is taking an increasing toll on our society.  The Biogen approval speaks to the importance of biomedical research and development in this country as well as the FDA’s Accelerated Approval Pathway program, which makes novel treatments available in areas of unmet need.

But the good news is not without controversy.  There is already criticism of the recommended market price of this product.  In that light, I found the blog post below from Genentech CEO Alexander Hardy to be relevant and insightful.  As he points out, the most effective pathway to achieve greater affordability for breakthrough medicines is to encourage more innovation and the development of competing therapeutics.  Remember the firestorm that occurred over price levels when Gilead Sciences developed a cure for Hepatitis C?  Those prices dropped precipitously when other biopharmaceutical companies developed competing products.  It’s an important lesson for policymakers that innovation is a more effective and patient-centered tool for achieving affordability than heavy-handed regulation.

I am pleased to share the perspectives of Genentech’s chief executive.

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Innovative Medicines Demand Responsible Pricing

The FDA approval of Biogen’s new Alzheimer’s disease medicine will be, I hope, the first of many new treatment options for patients to help combat this devastating condition. With this news, there has also been much commentary on the price of the medicine.

At Genentech, we’re well aware of the challenges of developing treatments for Alzheimer’s disease. We’ve spent the last decade researching potential targets and have experienced a number of scientific setbacks. But we’re proud to remain in the fight and are currently developing three investigational medicines – two in Phase II and one nearing Phase III completion. Despite the challenges, we remain optimistic about our potential to launch one or more medicines in the future.

Alzheimer’s is one of the biggest public health challenges of our time. The impact of the disease on patients and caregivers is truly tragic and we applaud Biogen for their efforts to develop a treatment.

We believe, like many others in the industry, that the price of a medicine must be based on the benefits it provides to patients and society. Ultimately, the price must enable patients to have rapid and broad access and provide a reasonable return that will fund future R&D investments.

Given the growing worldwide incidence of Alzheimer’s disease, it’s imperative that people with the  disease have multiple treatment options to choose from. Hopefully, a number of additional medicines will be approved that deliver more benefits to patients and society. With those advances, the resulting competitive market dynamics will prevail and bring a decline in prices. The availability of more therapies should drive healthy competition, delivering savings to the healthcare system overall and ensuring patients and doctors have important choices in the medicines they receive.

There is an opportunity now for lawmakers and industry to work together on policies that will fuel efficient market-based competition. We must also provide a safety net in the form of a cap on Medicare out-of-pocket costs to ensure that patients have access to life-changing medicines.

At Genentech, we’re committed to working every day to bring even more hope for patients and caregivers living with Alzheimer’s disease. If we are successful, we will price our medicines responsibly so that they reflect the benefit they provide to people with Alzheimer’s disease and society as a whole. We’re committed to working with the U.S. Administration, Congress, and others to find sustainable, system-wide solutions that lower costs while also protecting scientific innovation and ensuring patients have access to the life-changing medicines they need.