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Examining Comparative Effectiveness Research and Healthcare’s Future

March 10, 2016
1:23 pm

There is an event taking place next week that I would like to spotlight and recommend.  The National Pharmaceutical Council (NPC) is hosting a webinar on comparative effectiveness research (CER) and its potential effects on healthcare decision-making.  The webinar is taking place on Monday, March 14 from 2 to 3 p.m., ET.  You can register here.

In the webinar, NPC will be discussing the results of its sixth annual survey of healthcare stakeholders regarding CER and its possible impact.  Each year, the Council solicits the views of health care associations, payers, government officials and experts in academia to ascertain how and to what extent CER may be used to shape healthcare decisions and also to better understand the roles of different organizations in the public and private sectors in determining the direction of healthcare research as well as its funding and dissemination.

In the continued movement to strengthen health system value, comparative effectiveness research is an important factor to understand.  Ideally, this work can help clinicians better understand how new treatments can have an optimal effect on their patients.

The webinar will feature experts from NPC and Academy Health, as well as Dr. Joe Selby, the executive director of the Patient-Centered Outcomes Research Institute.  Healthcare organizations would do well to tune in.

Using Consumer Choice to Drive Value in Medicare’s Next Half-Century

August 06, 2015
3:45 pm

This summer, the nation has observed the 50-year anniversary of the Medicare program.  As we focus on Medicare’s next half-century and how we can ensure high-quality, accessible and affordable healthcare for tens of millions of current and future beneficiaries, it’s important that we have a clear understanding of what aspects of Medicare are working well in terms of elevating value.

The Medicare Today alliance recently released its annual survey, this one conducted by Morning Consult, of senior citizens throughout the country regarding their thoughts on Medicare Part D prescription drug coverage.  In existence now for just over a decade, Part D was one of the most important improvements to Medicare in the program’s history.  With a majority of older Americans coping with multiple chronic illnesses, it is impossible to overestimate the significance of this population having affordable access to prescription medications.

The survey of over 2,000 Americans over the age of 65 confirmed once again that Part D is fulfilling its mission.  Almost nine of every 10 seniors said they are satisfied with their Medicare drug coverage and 85 percent said the plan they selected delivers good value.  Eighty percent said their total out-of-pocket costs for their medications are reasonable.

The survey also found that seven of every 10 individuals receiving Medicare drug coverage said it is important for Part D to provide a selection of different coverage plans.

That last finding is significant.  There is an ongoing discussion in political circles regarding the private sector orientation of the Part D program.  Consumers have multiple plans from which to choose and drug prices are determined in private sector negotiations involving manufacturers, health plans and pharmacy benefit management firms.  This approach is clearly working well, exemplified not only by Part D’s popularity among seniors but also by the recent announcement by the Center for Medicare and Medicaid Services that average Part D monthly premiums would stay flat in 2016 at $32.50.

As we consider Medicare’s future, there are lessons to be learned here about the ability of consumer choice to drive quality, affordability and value.

When in Doubt, Always Opt for Choice

August 08, 2014
11:16 am

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued proposed regulations that would have made significant, sweeping changes in the Medicare Part D prescription drug program.  Among other aspects, the proposed rule would have placed new limitations on the number of Part D plans that plan sponsors could offer in a particular region.

In a logical world, policymakers would have first asked seniors if they felt the Part D program was inflicting too many plan choices upon them.  They didn’t, so the Healthcare Leadership Council (through our Medicare Today initiative) did.

We recently released our annual nationwide survey of U.S seniors evaluating their perspectives regarding their prescription drug coverage.  As has been the case in past years, satisfaction with Part D remains high, with almost 90 percent saying they’re pleased with their coverage and find it affordable.

More interesting, though, in context with the earlier CMS proposed rulemaking is the survey’s finding that three of every four seniors value having a wide choice of plans from which to choose and expressed concern with any changes that would limit those choices.

Ever since the inception of Medicare Part D, those who take a more patronizing view toward older Americans have asserted that they would be confused by having a number of plan choices before them.  This survey makes it abundantly clear that is not the case.

CMS pulled back on its efforts to make such drastic changes to the Medicare prescription drug program.  Before any further rulemaking takes place, federal regulators would do well to take into consideration what beneficiaries actually want.

A Case for Retiring America’s Worst Four-Word Phrase

July 07, 2014
2:44 pm

As summer heats up, so will the mid-year congressional campaigns.  When they do, we can unfortunately expect to hear more of the dreary rhetoric that arises every time Medicare comes up for discussion.  Candidate X will support changes to strengthen Medicare and improve its financial sustainability.  Candidate Y will respond by charging that Candidate X wants to do away with Medicare “as we know it.”

Even though the “as we know it” accusation was dubbed the Lie of the Year in 2011 by the PolitiFact fact-checking service, politicians continue to use it freely to score points against adversaries who propose any sort of change to the status quo.

A column in today’s New York Times – no bastion of conservatism by any measure – makes a strong case that it’s time to retire this four-word phrase for good.

Health economist Austin Frakt writes that enrollment in Medicare Advantage plans, operated by private health insurers, is increasing significantly, even after the federal cuts to Medicare Advantage plans that were part of the Affordable Care Act.  Today, approximately three of every ten Medicare beneficiaries are enrolled in one of these private plans and current trend lines tell us that proportion will continue to increase.

Frakt speculates that a reason for this growth is the comfort baby boomer beneficiaries have with private plans, having been enrolled in them throughout their working years.  He writes, “…baby boomers, who are just entering Medicare-eligibility age, are more accustomed to the types of insurance Medicare Advantage offers, such as H.M.O.s, than their predecessors were. Newly retired Americans have probably been enrolled in similar, employer-based plans for years if not decades — perhaps by the very same companies that offer Medicare Advantage plans — making it a relatively easy choice to enroll in such a plan for Medicare coverage.”

At the Healthcare Leadership Council, we have commissioned focus groups of middle-aged and older Americans to discuss their perspectives on Medicare.  Our findings closely mirror Frakt’s column.  We have found that Americans in their 40s and 50s are not at all averse to choosing between private plans for their Medicare coverage, and even seniors are adapting well to consumer choice after having experienced it for a decade now in the Medicare Part D prescription drug program.

We also found that, when assessing various options to address Medicare’s financial challenges, middle-aged and older Americans would rather use private sector competition as a tool to contain costs than see deeper cuts to physician and hospital reimbursements.

So when political candidates talk about fighting for Medicare “as we know it,” this phrase rings increasingly hollow.  Millions of beneficiaries are already rejecting the idea of an inflexible Medicare status quo and are gravitating to privately-run plans.  Perhaps it’s time for politicians to follow where the people are already leading.

Determined to Despair

June 17, 2014
4:18 pm

If you’re following health news this week, the predominant message you’re getting is that the United States health system is in exceedingly bad shape, at least compared to other prosperous nations around the world.  The left-leaning Commonwealth Fund released one of its periodic reports telling us that the U.S. ranks last in healthcare quality, access and other selected categories compared to ten other developed nations including Canada and the United Kingdom.

The report has received broad visibility from media outlets, most of which have reported the Commonwealth findings as presented without challenging or even questioning the report’s methodology.  Thus, we’re left with the understanding that healthcare in the United States is far inferior to those nations with systems in which government plays a much stronger role.

There are some, though, who have closely reviewed Commonwealth’s work and are saying the situation for the United States is not as relentlessly grim as the Fund is telling us.

Philip Klein in the Washington Examiner writes that the Commonwealth report is “rigged” to favor countries with government-run universal healthcare system, noting that the study gives high priority to “equity” while leaving out consideration of medical innovation.

He wrote, “It’s an ideological decision to view equity as one of the most important factors in judging a health care system, just as it is for the study to leave out a factor such as medical innovation, which would work to the advantage of the U.S., or choice, which would work against the centralized NHS (the U.K.’s National Health Service).”  Klein also writes that the U.S. ranks ahead of the U.K. in five-year survival rates for 22 of the 23 types of cancer, another success story in this country that didn’t find its way into the Commonwealth Fund methodology.

And Avik Roy, opinion editor for Forbes, wrote in National Review that the Commonwealth study relies not on hard data, but rather subjective surveys.  He wrote, “While it is interesting to look at such surveys, it is simply not serious to draw hard conclusions from them.  U.S. consumer culture is famously more demanding than that of other developed countries; while Americans still defer to their doctors and pharmacists, they do so appreciably less than Europeans do.  They are more likely to suspect error, and far more likely to sue if they believe an error has been made.  An international poll that does not even attempt to normalize for these cultural differences is not informative.”

Thus, Roy notes, Commonwealth gives the United Kingdom higher marks than the United States on timeliness of care even though the U.K. is notoriously poor in this department and certainly well below the U.S., where waiting times for care are significantly less than those in other countries.

There is no question that there is significant room for improvement in the U.S. healthcare system, and those involved in all sectors of healthcare are working every day to achieve higher standards.  The Commonwealth report, though, paints a darker picture than is justified by reality.