kamagra 70p

Home

Bringing Value to the Patient and the Healthcare System: A New Report

February 04, 2016
4:52 pm

This week the Patient-Centered Primary Care Collaborative (PCPCC) unveiled its fifth annual report on the patient centered medical home’s (PCMH) impact on cost and quality.  In the quest to improve population health and reduce cost, PCPCC has collected data from peer-reviewed studies on medical homes’ costs and utilization.  Several Healthcare Leadership Council (HLC) members – Anthem, Aetna, Johnson & Johnson, McKesson, Merck, Premier and Takeda — are executive members of PCPCC. The results are instructive in the continuing discussion on how to elevate healthcare quality while containing overall spending.  Key takeaways from the report include:

  • A focus on primary care drives down cost and utilization
  • Best results came from sites that used multiple payers
  • It is essential to align payment with performance

The panel that discussed the findings included Marci Nielsen, CEO of PCPCC, Alissa Fox, SVP of the Office of Policy and Representation at Blue Cross Blue Shield Association, Chris Koller, President of Milbank Memorial Fund, and Len Nichols, Director of the Center for Health Policy Research and Ethics at George Mason University.

The experts stated that PCMH’s have demonstrated the ability to control costs by providing the right care.  Delivery reform and payment reform go hand in hand; one will not succeed without the other.  As the nation works toward a value-based healthcare system it is important to be mindful of the cost of transformation.  Incentives must be right, there will be a need for antitrust exemptions, and the industry will rely on national standards but local relationships.  Currently, fee-for-service does not reimburse services that are key to coordinating patient care.  The PCMH model is not one size fits all, according to the panel, and more research is needed to identify which varying components are demonstrating the most value.  Defining measures and identifying best practices are necessary steps in ensuring successful implementation of the PCMH model.

This discussion on how to improve value within the healthcare system will reach an important juncture later this month when the Healthcare Leadership Council unveils specific policy recommendations – endorsed by virtually all sectors of the healthcare industry in addition to patient advocacy organizations – on how to remove barriers to quality-enhancing, cost-saving health innovations.  Watch this space for more information.

A Thoughtful Discussion on Drug Pricing and Innovation

October 05, 2015
11:53 am

There has been a lot of talk of late about the price of prescription drugs.  Most of it, unfortunately, has come in the form of 30-second sound bites, largely driven by one hedge fund investor’s decision to significantly raise the price of a single product.

Determining the correct price for an innovative, life-changing product to achieve both consumer accessibility as well as a return on investment, which is vital to fund future research and development, is a complex topic that warrants a thoughtful discussion, not glib attack lines.

Credit, then, goes to the Washington Post for its lengthy question-and-answer article with Joseph Jimenez, the CEO of Novartis, one of the world’s leading pharmaceutical companies.  In the interview, Jimenez made, I believe, several striking and instructive points.  Among them:

On price versus value:

“When you look at the cost of development, it continues to go up and up and up. So when we price a drug, we price it based on the value it will bring into that marketplace, and also how its price compares to the other therapies currently on the market. There’s been a lot of discussion about drug pricing. What we have to do is we have to shift that conversation away from the price toward the value. Like, what exactly is the value of this drug that is going to result in a positive outcome? And is society willing to pay for that drug?”

On the ability to use genomics to reduce the overall cost of drugs to society:

“Technology has improved so much in drug development that we now can find genetic markers on patients to ensure that they will benefit from our drug, and we’ll know those patients who won’t benefit from the drug. For example, we just launched a new lung cancer drug that only works in about 3 percent of patients with lung cancer, because only 3 percent have this particular genetic mutation. So we’re able to go to the payers and say, “Yes, this is an expensive drug in absolute, when you think about one patient taking this drug, but you’re not going to waste one dollar on this drug, because we’re only giving it to 3 percent of this population and the impact on the budget is quite small.”

On the value of pharmaceutical collaboration with academia:

“Academic collaborations are very important for the pharmaceutical industry because we do not spend money on basic research, we spend money on applied research. When there’s basic biology that has to be understood, an academic institution is going to be much better at doing that than Novartis. If we partner with them, we can take that learning and we can turn it into a drug.”

I recommend you read the full interview, which can be found here.  Mr. Jimenez’s thoughts provide a foundation for a reasonable discussion regarding medical innovation and patient access, the kind of conversation our society needs to have.

Documenting the Better Care, Lower Cost Advantages of Medicare Advantage

September 03, 2015
11:59 am

A study published in this month’s edition of the American Journal of Managed Care brings hard data to an argument many of us have been making for some time, that private Medicare Advantage plans are doing a superior job of delivering high-quality care at less cost than traditional Medicare.

The study, led by Dr. Bruce E. Landon of the Harvard Medical School and funded by a grant from the National Institute on Aging, examined price-standardized resource usage and care delivery for patients with diabetes or cardiovascular disease in both Medicare Advantage plans and traditional fee-for-service Medicare.  The takeaways from the study included:

•    For both health conditions examined, relative resource use was lower in Medicare Advantage plans than it was in traditional Medicare

•    Although there was variation among individual plans, quality of care for diabetes and cardiovascular disease was higher in Medicare Advantage plans.

The study concludes, “Proponents of managed care have long argued that integrated health plans can deliver care more efficiently than traditional fee-for-service care by using their ability to tailor their provider networks to the needs of their population and to implement disease and case management programs to improve chronic disease management.  In this large national study of enrollees with diabetes or cardiovascular disease, our findings suggest that many Medicare HMO health plans are able to deliver care of equal or better quality with lower (resource usage) than traditional Medicare.”

These findings, I would add, echo what we hear at the Healthcare Leadership Council on a regular basis from not only our health plan members, but also from hospital leaders – that, in terms of attacking chronic disease in a cost-efficient way, Medicare Advantage has a strong upper hand over conventional Medicare.

A Wise Withdrawal on Altering Medicare Part D

May 21, 2015
11:50 am

This morning, the House Energy and Commerce Committee voted unanimously – a rare event in these fractious political times – to send its 21st Century Cures legislation to the full House.  Progress for this measure, which will accelerate the development and delivery of new treatments and therapies while also making advances in healthcare data access and interoperability, is good news for patients and the healthcare system.

An interesting and positive development in the Energy and Commerce markup actually concerns something that didn’t happen.

One of the amendments scheduled for consideration this morning would have fundamentally changed the Medicare Part D prescription drug program by empowering the Secretary of Health and Human Services to negotiate drug prices, a responsibility now being handled by private sector health plans and pharmacy benefit management firms.

This is a status quo that isn’t begging to be repaired.  Just the opposite, in fact.  These private sector pricing negotiations have yielded a Part D program that has maintained beneficiary monthly premiums at a stable, affordable level for the past five years.  All the rhetoric in the world doesn’t change the fundamental truth that millions of seniors and beneficiaries with disabilities have affordable access to medication because of the way the Part D program is structured.

The drug pricing amendment was withdrawn before coming to a vote.  Medicare Part D stays on a path that has consistently won approval ratings of greater than 80 percent among Americans 65 and older.

Some efforts withdraw, as the saying goes, so they can live to fight another day.

Ill-conceived ideas like this one, though, should just call it a day and stay permanently out of the way of Medicare beneficiaries and the medicines they need.

Why the Roe-Sanchez Bill Matters

May 06, 2015
10:27 am

Thanks to the healthcare industry’s success in containing per-capita Medicare cost increases, it’s easy to make the case that there’s no urgency to repeal the Independent Payment Advisory Board (IPAB).  Current cost trends are not going to trigger IPAB’s power to recommend harsh cuts to Medicare expenditures, and the President hasn’t even appointed a nominee to the board.

That’s why this is exactly the right time to erase an ill-conceived idea off of the board.  Better now than when its destructive consequences are on our doorstep.

U.S. Representatives Phil Roe (R-TN) and Linda Sanchez (D-CA), joined by 220 additional cosponsors, have introduced the Protecting Seniors’ Access to Medicare Act, a bill that would repeal the provision of the Affordable Care Act which created this board of political appointees with unprecedented powers.  In addition to having the support of a majority of the U.S. House, over 500 national and local organizations representing healthcare providers, patients, employers and veterans have signed a letter urging Congress to enact IPAB repeal.

This critical mass of bipartisan support exists because IPAB is, quite simply, a bad idea.  Not only does it shift congressional authority to an unelected board, but the legislation creating IPAB prohibits judicial or administrative review of the board’s actions.  And with IPAB structured so that cuts to Medicare must be enacted within a one-year timeframe to meet spending targets, it means that long-term reforms to improve Medicare value and sustainability will take a back seat to short-term cuts to providers that will reduce beneficiaries’ access to care.

There is a need to make Medicare more cost-effective and there are ways to do it that warrant discussion.  Granting sweeping powers, however, to a board that is not responsive to the public and taking actions that reduce patient access at a time when the Medicare-eligible population is rapidly increasing are approaches we shouldn’t be pursuing.

We’re fortunate that IPAB hasn’t yet been implemented.  Congress should rapidly approve the Roe-Sanchez bill before it is.