April 04, 2016
As we’ve seen, there has been a steadily increasing level of discussion and enthusiasm surrounding precision medicine. The Healthcare Leadership Council (HLC) has remained engaged in this conversation, given the expertise and involvement of its members. HLC hosted a briefing on Capitol Hill last April on the subject, in which Bio-Reference Laboratories, New York-Presbyterian Hospital/Columbia University Medical Center and Mayo Clinic detailed the benefits that have already been realized, and the potential that has yet to be reached. They each shared stories of how targeted therapy transformed the lives of patients in ways that conventional medicine could not. Although the cost of sequencing will continue to benefit and see increased usage from price declines, early genetic testing has allowed for immediate diagnosis and treatment, bypassing the costly trial and error approach. Our member experts all agreed that one organization alone cannot succeed in integrating genome based knowledge into personalized care.
Last year the Precision Medicine Initiative (PMI) was announced by the National Institute of Health (NIH). This year the White House hosted a PMI Summit, in which President Obama both participated and partnered with the NIH in an educational tweet chat that answered questions from the public regarding the initiative. During this chat, NIH Director Francis Collins cited a paradox, “Only by studying populations at scale can you really understand individual differences.” The PMI Cohort Program is currently working towards collecting one million or more participants that reflect the diversity of our country.
Precision medicine is an area that would directly benefit from the ability to collect, store and share data electronically. In order to see real success, harmonization of data privacy laws is a necessary next step. Diverse state privacy regulations regarding patient information accompany HIPAA laws, adding to the complexity of sharing data in a way that would improve the quality of patient care. Federal rules for research subjects intersect with additional privacy policies that are also burdensome to the healthcare system. The ability to utilize any data gathered from partnering facilities is an important function, and dialogue between the federal government and states is needed to ensure this is feasible across the country. This is a field of health policy we have discussed fully in the Healthcare Leadership Council’s recently-released “VIable Options: Six Steps to Transform Healthcare Now” policy recommendations. The U.S. is on the cusp of a new era in healthcare, and the flow of health data is a crucial part of it.
January 06, 2016
In these early days of the new year, all eyes will be on the U.S. House as it prepares to pass legislation repealing the Affordable Care Act, which will go to President Obama’s desk for a certain veto.
There are far weightier developments likely to happen in 2016, however, and Susan DeVore, President and CEO of Premier, Inc. and chair of the Healthcare Leadership Council penned a recent article in Health Affairs that does an excellent job spelling out the trends we should be watching in the coming months. Among the developments she cites:
- With the coming implementation of new Medicare physician payment formulas and rules, physicians will be determining which payment model works best for their practices and understanding how to improve performance to meet new quality standards.
- Value-based contracting between providers and healthcare manufacturers will become more prevalent, with compensation ties to a product’s ability to meet certain performance criteria.
- Telemedicine will continue to prove itself as a cost-effective mechanism for managing patient care, spurring discussions on the service’s role in healthcare payment systems.
- To drive more market competition in the pharmaceutical market, Ms. DeVore projects speedier FDA approvals of new drugs. She notes that competition has already brought down prices of the much-talked-about Hepatitis C medications.
- The likelihood of legislation requiring more usability and interoperability among electronic medical records systems.
- Noting that health providers are faced with literally hundreds of different performance quality measures, she projects an effort to consolidate and simplify measurement systems among government and private payers.
The full Susan DeVore Health Affairs post can be found here.
June 30, 2015
There is an excellent read in the Wall Street Journal today from Susan DeVore, the President and CEO of the Premier, Inc. alliance of 3,000 community hospitals throughout the country. (Ms. DeVore is also chairman of the Healthcare Leadership Council.)
In her WSJ piece, Ms. DeVore notes that, while other industries have made excellent use of evolving information technologies to improve customer service and strengthen cost-efficiency, healthcare has lagged behind. Improved data sharing is essential, she writes, “to ensure the right information about the right patient is available at the right time.” She is absolutely correct in her assertion that making this happen is a responsibility shared by the private sector and public officials.
The DeVore column is below:
SUSAN DEVORE: Imagine what Twitter would be like if you were only able to have and Tweet to one follower? Or if email only worked within the four walls of your organization? Technology has made information sharing seamless and almost limitless for most people and industries. But it hasn’t reached its full potential in health care.
In health care, technology is foundational to drive change and improve the quality and value of patient care. The problem is that important health-care data cannot flow freely among the various health-information-technology systems that hospitals and health systems use. This hinders the ability for providers to connect and easily exchange information across their organizations and with other health systems.
As health systems focus on accountable care and increasingly move toward alternative payment models, the need for interoperable data across all health-information technology systems becomes critical. The ability to seamlessly pull discrete data anytime, anywhere helps to ensure the right information about the right patient is available at the right time. But today, providers are challenged with having to double check data pulled from disparate devices to make sure the information matches, such as dosing and blood sugar levels. Not only is this a step back for efficiency, but it is another manual process that has the potential to create errors and patient-safety issues.
To truly leverage health-information technology’s full potential, diverse networks and systems in health care must be able to talk to each other. To do so, we should require the use of innovative technology solutions such as open application programming interfaces (APIs) and secure third-party applications that connect the data to enable the real-time exchange of information.
Designing and implementing health-information technology that promotes collaboration among all stakeholders would create a learning health system that focuses on improving health-care quality, efficiency, safety, affordability and access. Private-public partnerships on interoperability governance, standards, measures and system transparency are essential to make this work.
A few weeks ago I was watching as my grandchildren were playing with their parents’ smartphones. At their ages, they are only interested in the bells and whistles, but in their little hands were devices probably considered impossible 10 or 15 years ago. Through innovation, ingenuity and necessity, my hope is that the challenge of interoperability becomes an obsolete concern.
May 21, 2015
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.
March 18, 2015
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