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The drug pricing amendment was withdrawn before coming to a vote.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.
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.
May 01, 2015
2:25 pm
Last week, Dr. Vivek Murthy, the new U.S. Surgeon General was officially sworn into office. In his speech to the ceremony attendees, Dr. Murthy described his mission for a stronger and healthier America. He discussed roadblocks to better population health such as a culture focused on treatment rather than prevention, the spread of incorrect health information and unhealthy behaviors that are entrenched in society and difficult to change. Addressing these issues, he said, is a shared responsibility requiring partnerships involving diverse interests and perspectives.
The Healthcare Leadership Council is proud to be a part of that partnership. In fact, one of the Surgeon General’s first public appearances in Washington, DC was at a forum HLC hosted on anti-obesity initiatives. At that forum, he joined with HLC member companies – Weight Watchers, Takeda Pharmaceuticals, Health Care Service Corporation and the Cleveland Clinic – to discuss the steps that are being taken to help more Americans understand the importance of and how to achieve healthy body weight. Dr. Murthy spoke compellingly about the need to create a culture that encourages healthier lifestyles.
The good news is that important strides are being made in developing that culture. In communities throughout the country (note Oklahoma City’s collective million-pound loss spotlighted at the HLC anti-obesity event), we’re seeing successes in establishing improved health and well-being. Healthcare companies, including many of our HLC members, are taking innovative steps to incentivize better nutrition and exercise habits. Many of these success stories are detailed in our publication, The Future is Here: Transforming American Healthcare Through Private Sector Innovation.
The need for progress is great. As was mentioned several times at our recent event, the percentage of Americans classified as obese has nearly tripled since the 1960s. This is taking an enormous toll not only on our well-being as a society, but also on the economic sustainability of our healthcare systems. We need to learn from the successes that have been established, and then build on them. On that note, we’re certainly aligned with our new Surgeon General.
March 18, 2015
11:41 am
On March 2, the Healthcare Leadership Council, as part of its National Dialogue for Healthcare Innovation (NDHI) initiative, brought together over 70 leaders from organizations and institutions that design, implement and are affected by the U.S. healthcare system. The purpose was to clearly define what constitutes value in healthcare and to begin crafting a pathway that will allow patients and consumers access to life-changing healthcare innovations within a structure that is affordable and financially sustainable.
The Summit on Value and Innovation was just the first step in what will be an ongoing dialogue designed to identify and address the existing barriers to health system improvement. Summit participants have expressed their intention to continue working toward the goals and objectives they outlines on March 2.
Here are some highlights of the comments and coverage of the NDHI Summit:
“Last week I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–provocateur Zeke Emanuel was there. The chief executives of providers, payers, pharmaceutical companies, government agencies—all there. And what were they there to do? Define “value” in health care.”
–Neel Shah, M.D., Executive Director, Costs of Care in the AAMC Wing of Zock blog
***
“In order to improve value, we needed to identify some of the obstacles that could thwart progress. Regulatory and policy challenges; trust between stakeholders; insufficient time for measurement and lack of tools for patients to make healthcare decisions were among the barriers we cited.
“To surmount those obstacles, we honed in on several key initiatives: piloting a payment model that incentivizes value and shares risk among stakeholders; mapping the patient journey to better understand how we as stakeholders can work together, rather than focusing on our individual part of a patient’s healthcare experience; and developing medication adherence programs to educate patients on their disease, therapies and treatment goals.”
–Greg Irace, Senior Vice President of Global Services, Sanofi US
***
Several participants said that the Medicare Advantage system does a good job of aligning incentives to produce high-quality care and good value. Barry Arbuckle, president and chief executive officer of MemorialCare Health System, which operates hospitals and provider groups as well as a health plan in the Los Angeles area, said, “If I could push every Medicare patient into Medicare Advantage, I’d do it tomorrow.”
Medicare Advantage is “a fundamentally better system. The financials are aligned. We have incentives to do disease-management programs. Frankly I don’t have that in Medicare, because I get paid when they get sick. And if they’re sicker, I get paid more,” Arbuckle said.
It’s more challenging to address these issues for the commercially insured population, Arbuckle said. Having a long-term relationship with members is crucial to the success of creating better health-care value, he said.
–Coverage in Bloomberg BNA, March 3, 2015
January 28, 2015
5:03 pm
I guess it shouldn’t be surprising that a television news program would give a complex topic like the nation’s healthcare system a treatment that could be described as, well, glib. That occurred on CBS’s “60 Minutes” earlier this month when a correspondent suggested that healthcare institutions are raising prices “willy-nilly.” That description, besides being particularly nonilluminating, falls far short of explaining the evolving relationship between healthcare providers and the innovative companies creating medical technologies. The fact is, there is an intensifying effort on the part of both parties in this buyer-seller interaction to demonstrate how medical devices can lead to better patient outcomes, lower costs and, subsequently, greater value. I want to share an excellent interview on the topic that Edwards Lifesciences Chairman and CEO Michael Mussallem (a Healthcare Leadership Council member) in which he describes how his company and his hospital customers “make sure that the money they’re spending for our critical supplies helps their clinicians achieve their goals.”
Modern Healthcare: How has provider consolidation affected Edwards’ growth strategy?
Michael Mussallem: Because our products are so important clinically, our primary customer would have been physicians. More and more, there’s been involvement from economic buyers that want to make sure they understand the economic value of our products along with the clinical value. That’s probably the single biggest change. We don’t necessarily feel like we need to be large, but we feel we need to be really good. We need to be trusted. We need to show up with evidence. And we need to support providers in providing great healthcare for patients.
MH: How has Edwards changed the way it sells the value of its products to health system administrators?
Mussallem: We’ve gotten a clear message that administrators want to hear from clinicians that our products offer high clinical value. They want to see the evidence. So we have in a very organized fashion pulled together all the clinical evidence that talks about, for example, the nearly 30 years of data on the distinguished performance of Edwards’ heart valves. We also established a health economics group, which helps us assemble the economic evidence supporting Edwards’ products. That group also provides direct assistance to providers on how they can improve the value they offer to their patients.
MH: What are you doing to offset the pricing pressure associated with provider consolidation?
Mussallem: Hospital systems are aggregating their volumes and are becoming far more sophisticated in the way they purchase. We try and live up to that sophistication by being able to address all the questions that they have. Our experience is they really want to deliver great value to their patients, and they want to make sure that the money that they’re spending for our critical supplies helps their clinicians achieve their goal. We’re happy to be able to do that. It means we’re required to be more sophisticated and bring more evidence than we ever have in the past.
MH: Has that changed the way you’re designing clinical trials?
Mussallem : We’re most known for our innovations in transcatheter heart valves, which are valves that can be replaced without open heart surgery. In large randomized trials, not only are we collecting clinical data on the impact on mortality and the other complications, we’re also collecting quality-of-life data, health economic data. These data show how cost-effective this therapy is compared to past therapies or other alternatives.
MH: How receptive are hospital administrators to technologies you’re developing or selling that help reduce cost?
Mussallem: It depends. It certainly helps when we have clinicians who are passionate, who understand what kind of opportunities exist and have good, open dialogues with their administrators. We’re finding more receptivity among administrators than we’ve ever found in the past as they try and solve problems that weren’t easy to solve when you operate a hospital system more in silos. But now, when you look at it as an entire patient encounter—how much value do we deliver for what cost—it becomes a conversation that high-level administrators are having with us more often.
MH: How are you talking to administrators about technology like your ClearSight noninvasive technology, which can add cost per patient but may save money in the long run?
Mussallem: The theme of what we’re trying to help hospitals with is what we call enhanced surgical recovery. The idea is if you achieve proper fluid balance before a surgery, you can reduce complications and shorten length of stay, and there’s a tremendous amount of data that supports that.
Our new ClearSight technology allows a noninvasive way of collecting that sophisticated information. With an investment of about $300 upfront, you are able to save literally thousands on the back end and improve patient satisfaction in the process. This was something the British National Health Service implemented, and we’re trying to help adoption in the U.S. today.
MH: Are hospitals willing to spend more money on a technology like this?
Mussallem: I think hospitals are getting it. In the past, for example, there would just be an anesthesia budget, and they would just see the increased cost in that budget but not see the reduced cost from the shorter length of stay or the reduced complications. Now, there are administrators for whole service lines who are taking a broader look at hospital economics, so they are very interested in this kind of approach.
MH: Edwards announced in December that it invested in a company called CardioKinetix. Do you anticipate that the company will make other deals like this?
Mussallem: Our strategy continues to be very focused, with 95% of the products we sell in the No. 1 position around the world. So we don’t try and be very large and diversified. We try to be excellent at what we do, and we’re totally focused on structural heart disease and critical-care monitoring. The CardioKinetix investment is a great example of a new therapy that has some tremendous promise for heart failure patients that have few options. They’re in a randomized clinical trial, and we won’t know the results for a couple of years. But it’s a perfect example of the kind of thing that Edwards likes to invest in—early stage potential breakthrough technologies that change medical practice and produce much better answers for patients.
MH: What’s your expectation for Congress repealing the ACA’s medical-device tax?
Mussallem: We’re pleased that there seems to be bipartisan support for re-examining the medical-device tax, and we think the odds of that making progress have improved. It is going to take a bipartisan effort. It’s probably going to take support from the White House. We’re cautiously optimistic that we will have some progress this year.
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