A Multisectoral Approach to Patient-Centered Care

August 08, 2023
12:22 pm

The Healthcare Leadership Council (HLC) hosted a webinar focused on how various healthcare organizations have approached value-based care and the outcomes associated with those methods. While, historically, providers have been financially compensated for the volume of services they provide, it has been increasingly recognized that a holistic view of patients’ health includes additional lifestyle factors and results in a healthier population while reducing the cost of care. The panel consisted of four expert representatives from HLC’s membership.

Dr. Adam Solomon, chief medical officer of MemorialCare Medical Foundation, compared traditional fee-for-service (FFS) care to different types of accountable care organizations (ACOs), highlighting the notable difference in relationships between services and payments, as well as outcomes. Lack of coordinated care in a FFS system leads to a separation of clinical data, pharmacy data and claims data, whereas ACOs enable the communication necessary to provide a coherent record of the patient’s medical history. Dr. Solomon mentioned the importance of incentivizing innovative alternative payment models outside of Medicare, and also stated that Congress and CMS should continue to support the migration from Medicare FFS to value-based Medicare Advantage to ensure seniors have access to coordinated care, which improves both patient experience and outcomes.

Dr. Justin Barclay, vice president of consumer insights and analytics at Tivity Health, discussed how his organization partnered with HLC on a study of care coordination perceptions among FFS enrollees, using a nationally representative sample of seniors aged 65 and over who are enrolled in FFS Medicare coverage. Some key takeaways from this study include: seniors in FFS Medicare agree that care coordination leads to better healthcare decisions and increases access to quality healthcare; despite high awareness, only four in ten seniors have experienced care coordination; and seniors who have experienced care coordination place greater trust in their primary care physicians, specialists, pharmacists and health plans over social media and traditional news media. Dr. Barclay recommended further research to examine the differences in experienced care among underserved populations.

Dr. Mark Montoney, chief medical officer of Wellvana, explained the burnout experienced by primary care providers stemming from the burden of administrative tasks and poor work-life balance, while receiving less reimbursement for services than other types of providers. Addressing this dilemma, Wellvana manages three ACOs across 22 states, which provide support to providers in areas such as coding, care management and patient education. Dr. Montoney described how care constantly improves in this environment because ACOs cannot succeed unless patients and providers win first, and better care coordination results in shared savings for the care team through improved outcomes. He shared that ACOs have generated over $17 billion in gross savings for Medicare over the last decade and patients have received elevated care between visits.

Dr. Hirsh Sandesara, the lead medical director for value-based provider engagement at Blue Cross NC, described his organization’s efforts to rapidly build a network of ACOs across the state in order to balance rewards for better health outcomes and lower cost of care rather than incentivizing a greater volume of services. This transition has led to a significant and sustainable long-term impact on quality and affordability. The data for the 1.4 million members has shown increased screening for colorectal cancer, improved management of high blood pressure and a reduction in hospital readmissions. These improvements in quality have translated into reduced healthcare costs, with a cumulative of nearly $500 million in savings since 2019, and over $300 million going back to providers as incentives for maintaining the health of their patients. Blue Cross NC is committed to bringing payers and providers to the same table to collaborate most effectively toward a patient-centric system.

Embedding Health Equity into the Core of Healthcare

April 04, 2023
7:44 pm

The Report of the Secretary’s Task Force on Black and Minority Health was released in 1985, serving as a catalyst for the U.S. Department of Health and Human Services (HHS) to begin addressing health disparities, and Congress to form the Office of Minority Health within HHS the following year. Today, much of the progress in this arena is taking place in the private sector. The healthcare industry is taking steps to achieve health equity with considerable vigor and with some lessons learned under its belt. The Healthcare Leadership Council (HLC), representing all health industry sectors, released a report in January 2023 with ZS, entitled, “Addressing Health Equity: Practical Solutions to Address Variations in Care,” identifying multiple structural barriers in both the private and public sectors that contribute to existing health disparities. The report was followed by a release stating HLC members’ commitment to shared principles aimed at eliminating health disparities. HLC also recently hosted a webinar, “Breaking Down Barriers to Achieve the Highest Level of Health,” in which representatives from its member companies discussed current strategies and overarching philosophies. The panel was made up of three participants:

  • Joneigh Khaldun, MD, Chief Health Equity Officer, CVS Health
  • Josette Gbemudu, Executive Director, Health Equity and Social Determinants of Health, Merck
  • Keith Dawson, Principal Science Leader, Global Health Equity and Population Science, Genentech

Dr. Khaldun opened by describing CVS’s enterprise-wide health equity strategy, highlighting the need to empower all employees by educating them about systemic inequities and providing tailored training for cultural competency. Dr. Khaldun also talked about measuring what matters to uncover inequities and utilizing these insights to design programs and policies to address them effectively. Examples of specific programs included CVS’s Community Equity Alliance, which aligns academic, community and healthcare partners to expand and integrate community health workers into care teams, and its workforce innovation training centers, which support job training needs across the country. Dr. Khaldun noted that disparities took centuries to develop, and that health equity is a journey that will not be achieved by one initiative in a short period of time.

Josette Gbemudu echoed Dr. Khaldun in that there must be internal integration of health equity across an entire business and not just through one initiative. She pointed to Merck’s $650 million commitment to improving maternal health globally and how it is using the learnings to embed health equity into its core business functions. Citing numerous statistics to show the broad range of disparities, Josette shared that Merck is not just focused on addressing social determinants of health barriers such as food insecurity, health literacy and health access, but it is dedicated to strengthening the entire health ecosystem. Merck Foundation launched a $20 million initiative to advance equity in U.S. cancer care. Josette emphasized that many communities have historically been unable to access screenings, which leads to later diagnoses and poorer outcomes. The alliance is utilizing a collaborative approach to build community partnerships in order to address barriers to care.

Keith Dawson discussed Genentech’s efforts to develop solutions that will broaden inclusion of historically underrepresented groups in clinical research so that all patients can realize the full benefits of personalized healthcare. He stressed that clinical research is not benefiting all groups equally, that genomic data is not diverse enough and that Blacks and Hispanics are not informed about clinical trial opportunities. The diversity of patients enrolled in clinical studies is highly correlated with site personnel diversity, he pointed out. Keith stated that Genentech prioritizes fostering belonging and cultivating an environment where all are included. The Advancing Inclusive Research Site Alliance Partnership was created to develop an ecosystem based on trust and meeting patients where they are. This alliance uses an external council of advisors and patient and provider partnerships to provide educational tools to improve awareness of clinical trials. It also distributes grants to external organizations striving to address inclusive research, equity in care and workforce diversity.

Educational Effort to Increase Vaccine Adherence

June 27, 2022
3:18 pm

Vaccines are integral to preventing diseases and reducing the chance of illness for individuals. They significantly lower the risk of severe illness and hospitalization, and even death, as well as preventing the spread of diseases. Vaccines have been critical in reducing the spread of several different diseases including COVID-19 and the flu.

YourVaccinationGuide.org, created by the California Chronic Care Coalition and the Healthcare Leadership Council, provides reliable information regarding vaccines for COVID-19 and other diseases, and offers resources for obtaining vaccinations. This website works to fight misinformation and uncertainty by educating the public and promoting the success of vaccines. The site offers reliable information to reassure consumers regarding the safety of vaccines and provides supporting evidence of their effectiveness on a global scale.

Your Vaccination Guide emphasizes the importance of vaccine adherence by highlighting the significant benefit of vaccines, especially for people who are considered high-risk for severe illness. Vaccines can substantially decrease the rate of spread and infection. This protects everyone, including people of higher risk. The goal is that everyone should aim to be vaccinated from diseases. While even with a vaccine one can still contract the disease, the severity of the illness will be significantly lowered and much more manageable compared to that of an infected unvaccinated person. The site offers statistical data which makes a compelling case for the importance of being vaccinated.

YourVaccinationGuide.org is a helpful tool for those searching for more information regarding vaccinations and for people who question the need or safety of vaccination. It underscores the millions of lives saved every year, and the thorough testing for safety that takes place continuously even while vaccines are in use. This page is also available in Spanish and provides a page of frequently used terms and their definitions to assist with health literacy.

Improving Diversity in Our Clinical Trials for Long-term Health Equity

June 01, 2022
2:19 pm

Across the healthcare industry work is taking place to address health disparities. The Healthcare Leadership Council (HLC) has delved specifically into social determinants of health, broadband access, disparities in care delivery, vaccine acceptance, behavioral health, and workforce and clinical trial diversity. Amgen, an HLC member, is a leader in improving clinical trial diversity as a means to ensure better outcomes for those of diverse racial and ethnic backgrounds. This recent post below lays out the company’s comprehensive strategy, strengthened by collaboration, to address systemic issues which affect participation in research.

Improving Diversity in Our Clinical Trials for Long-term Health Equity

Darryl Sleep, Amgen’s senior vice president and Global Medical and Chief Medical Officer

Last April, Amgen stood with PhRMA as the first-ever industry-wide Principles on Clinical Trials Diversity officially took effect. The goals of these Principles are to expand participation among diverse patient populations by increasing understanding and awareness about clinical trials and improving access. Since then, we’ve already seen two very significant positive outcomes. First, improving diversity and representation in clinical trials has evolved from a niche issue into a core industry commitment. Second is the development of enthusiastic, industry-wide initiatives to improve how sponsors approach and improve diversity and representation in clinical trials. We are sharing best practices and de-identified aggregated clinical trial data to continue advancing this work via our cross-industry collaborations and partnerships. In this purpose, there is no holding back; we are all dedicated to making long-overdue changes that will result in diversity and representation in clinical trials becoming a reality and not just an ideal.

Clinical trials are a critical part of the long and careful process of developing new medicines. This research is complex and multidisciplinary and there isn’t a single accelerator that can be used to address the systemic issues that deter people from participating. Instead, we need a range of different levers to update decades-old processes and create new best practices.

I want to use the one-year anniversary of the PhRMA Principles to share some highlights about the data-driven efforts we’ve taken at Amgen to lead the way in breaking down barriers and help us find new medicines supported by clinical trials that are representative of all patients who suffer from serious illnesses.

We have a dedicated team
While the push for more diversity and inclusion in clinical trials is not new to Amgen, we accelerated our efforts in 2020 with the formation of RISE (Representation in ClInical ReSEarch), a team dedicated to addressing the systemic issues that deter people from participating in research, especially those who have been historically excluded due to race, ethnicity, sex, age, and other factors. We have significant momentum with our goals as programs and teams across Amgen, including RISE, Global Medical, Advocacy, Compliance, and Global Development, trial execution and data & analytics teams work together to create greater equity through diversity and proportional representation in clinical trials.

Ongoing learning to gain understanding and insights
Communication and information-sharing are fundamental to driving change. The output from our Health Equity Summit: Disrupting Health Disparities through Partnership and multiple Community Advisory Boards focused on direct insights from Black, Indigenous and People of Color (BIPOC) which provided information on barriers, strategies, and tactics that can apply across communities. We are using these insights to directly inform the design and implementation of a long-term, study-agnostic community engagement plan – a critical step in building sustainable, trusted relationships. Additionally, our patient-focused advisory councils with representation of racial and ethnic minorities will inform our clinical trial design and execution.

Building foundational capabilities
Logistical and financial barriers, gaps in awareness, and lack of trust all impact participation in clinical trials. We are partnering with organizations and diverse suppliers to thoughtfully build our enrollment support capabilities, including providing transportation, and other potential support capabilities, as well as finding optimal ways to support staff at clinical trial sites. Taking a holistic approach to tackling these industry-wide issues will help us move the needle.

New partnerships and collaborations
Collaborative partnerships play a significant role in advancing understanding of the science and our ability to positively engage patient communities in clinical trials. Toward that end, we are engaged in a number of efforts including:

  • A pilot program of the American Cancer Society Cancer Action Network to test a trial eligibility screening intervention intended to increase and diversify patient enrollment in cancer clinical trials, including navigators to help patients address logistical and financial challenges to enrolling and completing those clinical trials.
  • The CEO Roundtable on Cancer’s Going for Gold initiative, in partnership with Historically Black Colleges and Universities (HBCUs) and Hispanic Serving Institutions (HSIs), that focuses on equitable cancer care.
  • A collaboration with The Digital Medicine Society (DiMe) to drive inclusion in digital clinical trials by providing the tools and framework necessary to successfully engage underrepresented populations during the planning process for clinical trials that include a technology device for participation.
  • Creation of the HBCU BioTech Fellowship program, a professional development program that will prepare and empower 50 students (and soon-to-be graduates) from Historically Black Colleges and Universities for careers at Amgen.

Measuring progress in our own trials
We have undertaken important steps including a baseline study that will help us measure progress for trials currently underway as well as for new trials on the horizon. Additionally, we have a number of tools in development to help us measure and evaluate best practices for improvement in enrollment of participants from diverse racial and ethnic backgrounds.

Recognizing differences in disease incidence, exposure and response to medicines
We have long been committed to unlocking the potential of biology for all patients suffering from serious illnesses using advanced human genetics to unravel the complexities of disease. Accordingly, we are using data on human diversity in our own labs and with research partners. Together, we will better understand incidence of obesity, cardiovascular disease from risk factors such as elevated Lp(a), inflammatory diseases such as atopic dermatitis and lupus, and multiple cancers in diverse populations.

In addition, we are seeking to understand and actively address the social determinants of health (SDOH) that contribute to wide health disparities and inequities that impact disease burden and access to healthcare.

Reaching the finish line will allow us to get new medicines faster to patients who need them. It will also help doctors assure their patients that the medication they’re being prescribed was studied in people like them, with results that indicate they are likely to benefit. We’re not there yet, but we’re taking informed steps with care, with the scientific expertise for which we are known, and with humility. Every day, we dedicate ourselves to serving patients by transforming the promise of science and biotechnology into therapies that have the power to restore health and save lives. As we work to fulfill our own values and PhRMA’s Principles, we’ll get closer to serving all patients, beginning with clinical trials that include people of all races and ethnicities who will benefit.

For more information, please visit Clinical Trial Diversity & Representation.

Prescription E-Labels are Past Due

November 30, 2021
12:32 pm

Now decades into the digital age, most tasks can be completed electronically – ordering food, booking appointments, transferring funds, and even signing contracts. In the healthcare world, medical records and laboratory results can be accessed online rapidly and securely. Technological advancements have made these activities convenient, user-friendly and efficient.

And yet, there are corners of American healthcare that have continued to utilize paper as though the digital option is not available. More than 100 billion pages of paper are printed and distributed as package inserts for medications delivered to pharmacies each year. While this is environmentally wasteful, there are also safety implications with this process. Labels can be revised multiple times a year, and when that change is approved it can take up to a year for the updated paper copy to make it through the supply chain to the pharmacists. The delay can lead to conflicting information being provided to pharmacists and result in erroneous prescriptions negatively impacting the health of patients.

The National Institute of Health manages the National Library of Medicine’s DailyMed website, and has been posting the electronic prescribing information it receives from the FDA since 2005. In fact, in 2014 the FDA recommended that the default method of providing prescribing information be switched from paper to electronic, but the proposed rule has continuously been blocked by Congress. Most providers already rely on real-time electronic updates, as FDA-approved changes are immediately updated on DailyMed. It is not surprising that the physical labels, which are printed so small they are nearly impossible to read, usually get thrown away without a second glance as the most up-to-date information is readily available online.

Moving to a digital form is not just more convenient for prescribers, but for patients as well. If a medication comes with a QR code, the patient can access the updated information and be alerted to any changes or product recalls. They could also use a search function to jump to text with personalized information, augment the font, or watch videos that explain how to administer the medication. The opportunities to engage patients, increase medication adherence, reduce environmental impact and save money are infinite. The time for prescription e-labels is well past due.