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Joseph Gaspero

Patient Engagement and Cancer

By | Healthcare Access, Healthcare Costs, Patient Engagement, Patient-Driven Healthcare, Patients | No Comments

The Cancer Moonshot Initiative was announced by former President, Barack Obama on January 12, 2016. He tasked his Vice President, Joseph Biden, with heading the operation, encouraging the collaborations, and funding opportunities this initiative will need to successfully bring about the cure to cancer by the year 2020. Biden, who lost his son to cancer in 2015, has said that this hits too close to home for so many Americans and asks to hear your story.

 

A large part of the over goals of the Cancer Moonshot is to bring about the cure for cancer, but this isn’t the only value it can bring. Great strides have been made in the last year, it’s important to take a step back and evaluate how these leaps and bounds will affect those whose lives are already being negatively impacted by cancer. What has already been done to make the process of diagnostic testing, receiving a diagnosis, and starting/continuing treatment easier?

 

As it stands, the process of navigating through existing red tape between different healthcare facilities can be difficult.

Patient Engagement

In recent years, the importance of patient-driven medicine has come to the forefront of the medical field. It has become more important than ever for cancer patients and their families to stay in communication with their doctors following their diagnosis. With the changing landscape of cancer treatments, involvement from patients and their caregivers is a necessity.

 

For patients of rare cancers, such as mesothelioma, a cancer diagnosis can bring forward a whirlwind of paperwork, phone calls, and appointments with specialists. The need for comprehensive cooperation between organizations can help to make this period of time easier and should be a priority for the coming years.

 

With easier access to medical records of patients, they have a hand in their own care. This can bring a much needed feeling of stability to those whose lives have been uprooted by a diagnosis. Not only will better patient engagement lead to more empowered patients, but patients who have a better understanding of their own healthcare issues and treatment plans.

 

The Mesothelioma Cancer Alliance is dedicated to sharing real and relevant information to help those who have been diagnosed with mesothelioma, or any other type of cancer, through the difficulties of treatment and caregiving.

 

Dr. Jason Arora, CHI Research Group Member & Director at ICHOM Named to Forbes 30 Under 30 List

By | Healthcare Value, Volume-to-Value | No Comments

LONDON (January 19, 2017) – Jason Arora of the International Consortium for Health Outcomes Measurement (ICHOM) and Member of the CHI Research Group, was named in Forbes’ second annual “30 Under 30 Europe” list, a list that features 300 young innovators, entrepreneurs and leaders across Europe who are under 30 years of age and who are transforming business, technology, science, finance, media, culture and more, as judged by some of the most accomplished and acclaimed individuals in each category.  For the full list, please visit: www.forbes.com/30under30europe.

 

Jason Arora is a medical doctor, public health scientist and rising global expert in value-based healthcare, which focuses on delivering the best possible outcomes for patients at the lowest possible cost. Dr. Arora has helped grow ICHOM from a startup to innovative healthcare catalyst, successfully inspiring governments, hospitals and life-science companies to adopt the concept.

 

The Forbes 30 Under 30 Europe list covers 10 categories – Arts, Entertainment, Finance, Industry, Media, Policy, Retail & Ecommerce, Science & Healthcare, Social Entrepreneurs and Technology – with each of the honorees vetted by a panel of expert judges in their respective fields.

 

Randall Lane, Editor of Forbes, said “Researching, vetting and launching Forbes’ second annual 30 Under 30 Europe list was an incredible task.  We scoured the continent to find the most talented millennials and, with the help of our expert judges, are proud to honor 300 of the most important young entrepreneurs, creative leaders and brightest stars in Europe right now.”

The criteria for honorees making the list included leadership and disruption in their field; entrepreneurial mindset and results; and the likelihood of changing their field over the next half-century.

 

The judges have created a unique list of the 300 prodigious stars who are making a difference in our world.  The judges were:

 

  • Arts: Jeremy Till of University of the Arts London, Chef Heinz Beck, and Italian photographer Oliviero Toscani;
  • Entertainment: Forbes editor Mike Ozanian, Afrojack, and British director SJ Clarkson;
  • Finance: Klaus Hommels of Lakestar, Henning Potstada of DWS, and Sonali De Rycker of Accel Ventures;
  • Industry: Phillip Greenish of Royal Academy, Stephane Israel of Arianespace, and former 30 Under 30 Honoree Cornel Amariei of Continental Automotive Systems;
  • Media: Kai Diekmann of Bild, Antonia Rados of RTL Group, and Max Guen of Magna Carta TV;
  • Policy: Josef Janning of European Council on Foreign Relations, Richard Youngs of Carnegie, Endowment Europe, and Brigid Laffan of European University Institute;
  • Retail: Amber Atherton of My Flash Trash and Dharmash Mistry of blow LTD;
  • Science: Barbara Prainsack of King’s College London, Jason Levine of IT and Clinical Informatics at National Cancer Institute, and Iain Woodhouse of University of Edinburgh;
  • Social Entrepreneurs: Forbes Editor Randall Lane, Cheryl Green from Echoing Green, and Jean Case from Case Foundation;
  • Tech: Brent Hoberman of Lastminute.com, former 30 Under 30 Honoree Ophelia Brown at Local Globe, and Tom Hulme of Google Ventures.

 

The complete list, along with video interviews with some of the honorees, is online at www.forbes.com/30under30europe.

 

Forbes’ Under 30 franchise is a global multichannel platform, that comprises 30 Under 30 lists featuring young global game changers published in print and online all over the world; live summits in the U.S., Asia and Israel; an Under 30 channel on Forbes.com; and a Forbes Under 30 app. To access Forbes magazine’s 2017 30 Under 30 U.S. list, please visit www.forbes.com/30under30.

 

 

For these stories and more, visit www.forbes.com

Follow Forbes on Twitter (www.twitter.com/Forbes)

 

 

How Does Patient Engagement Drive Value?

By | Collaboration, Global Healthcare Trends, Healthcare Innovation, Healthcare Value, Patient Engagement, Patient-Driven Healthcare, Patients, Volume-to-Value | No Comments

The 21st-century healthcare landscape is characterized by a consumer-driven, patient-centric model of care delivery, with patients, their caregivers, and advocacy groups playing a vital role in today’s healthcare ecosystem. Patients and their families are taking an active role in their healthcare and proactively interacting with providers and other healthcare stakeholders to improve health and wellness. Today’s patients are better informed and more financially invested than ever before, and they play a key role in decision-making processes that can positively impact health outcomes.

 

This paradigm shift has dramatic implications not only for patients – but also for providers, biopharma, and payers. As healthcare costs pressures continue to increase, incentives are shifting from a fee-for-service environment to a value-based healthcare system. More than ever, it is critical to understand how patient engagement drives value for patients, providers, biopharma, and payers, and ensure your organization is aligned to operate in the new healthcare economy.

 

The How Does Patient Engagement Drive Value? Healthcare Executive Roundtable on Thursday, 10/13/16 in Manhattan, NY, is an expert, cross-sectoral collaborative discussion designed to help healthcare stakeholders optimize engagement, communication, and collaboration. The exclusive, limited-attendance roundtable is designed to provide the top thought-leaders, visionaries, and executives from the patient advocate, provider, biopharma, and payer spaces with the latest insights and ideas on how patient engagement drives healthcare value for all stakeholders. The roundtable focuses on pragmatic and actionable ideas designed to empower you and your organization to understand the intersection of patient engagement and healthcare value. Additionally, the Healthcare Executive Roundtable helps healthcare stakeholders build open and collaborative relationships to positively impact healthcare delivery and outcomes.

 

We have a very limited number of registrations remaining. Please visit chisite.org/education/healthcare-executive-roundtable for more information. We invite you to join us for a day of thought-provoking discussion regarding patient engagement and healthcare value.

The Economist Explores: Why Has Cancer Not Been Cured?

By | Uncategorized | No Comments
In a recent article by The Economist, a simple question was asked: Why has cancer not been cured? Despite a forty year war against the disease, that questions has no simple answer. Research has taught us that more than a mutation of genes, cancer is a disease of specific organs. New therapies are increasingly providing personalized solutions to harness the body’s own immune system in fighting cancer, but more still needs to be understood about the molecular mechanisms that drive it.

On September 28th in Boston at the War on Cancer conference, editors of The Economist will gather more than 200 global health-care players, including Flatiron Health, Memorial Sloan Kettering, IBM, MD Anderson Cancer Center and others to discuss the technological advancements improving our ability to fight cancer and expand access to targeted, quality cancer care.

Some of our notable speakers participating in the event include:

  • Amy Abernethy, Chief medical officer and senior vice-president of oncology, Flatiron Health
  • Christina Åkerman, President, International Consortium For Health Outcomes Measurement (ICHOM)
  • Peter Bach, Director, center for health policy and outcomes, Memorial Sloan Kettering
  • Amitabh Chandra, Director, health policy research, Harvard Kennedy School of Government
  • Kathleen Kaa, Global head of pricing and market access, Oncology, Roche
  • Kyu Rhee, Chief health officer, IBM

You can save 15% on the current available rate when you register with our special code: CHI15

The Economist’s Healthcare Forum: War on Cancer

By | Global Healthcare Trends, Healthcare Innovation, Healthcare Value, Patients | No Comments

While advances in cancer treatment have come a long way, cancer remains among the leading causes of death worldwide. Though the promise of technology allowing for faster, more precise treatment and more collaborative health care models is inching us closer to victory, scaling the progress made thus far remains a critical next step.

 

On September 28th in Boston, editors of The Economist, experts and thought leaders from across the healthcare ecosystem will gather at the War on Cancer Forum to discuss and debate how innovation can be scaled across policy and financing, prevention, early detection, treatment and long-term management of this deadly disease. Don’t miss the opportunity to network with 200 of your peers and those making major progress in the war on cancer.

 

Some of our notable speakers participating in the event include:

  • Amy Abernethy, Chief medical officer and senior vice-president of oncology, Flatiron Health
  • Christina Åkerman, President, International Consortium For Health Outcomes Measurement (ICHOM)
  • Peter Bach, Director, Center for health policy and outcomes, Memorial Sloan Kettering
  • Roy Beveridge, Senior vice-president and chief medical officer, Humana
  • Amitabh Chandra, Director, health policy research, Harvard Kennedy School of Government
  • Sally Cowal, Former Ambassador, US Government and senior vice-president of global cancer control, American Cancer Society
  • Jason Efstathiou, Director, Genitourinary division, department of radiation oncology, Massachusetts General Hospital
  • Gilles Frydman, Co- founder, Smart Patients
  • Kathy Giusti, Founder, Multiple Myeloma Research Foundation
  • Kathleen Kaa, Global head of pricing and market access, Oncology, Roche
  • Kelvin Lee, Co-leader, tumor immunology and immunotherapy, Roswell Park Cancer Center
  • Greg Matthews, Managing Director, MDigital Life
  • Josh Ofman, Senior vice-president, global value, access and policy, Amgen
  • Kyu Rhee, Chief health officer, IBM
  • Lowell Schnipper, Chair, value in cancer task force, ASCO

Save 15% on the current available rate when you register with our special code: CHI15

How Can We Boost Patient Engagement?

By | Healthcare Innovation, Healthcare Quality, Informed Patient, Patient Engagement, Patient-Driven Healthcare, Patients | No Comments

Young smiling doctor consoling patient sitting on wheel chair outdoor

Many industries today focus on strengthening consumer engagement with their products and services. Whether it’s via social media, websites, mobile apps, video media, or televised commercials, companies across the globe know the importance of marketing their products, services, and technological advances in maintaining profit margins and consumer satisfaction levels. The healthcare industry would be wise to follow similar industry strategies in order to strengthen patient engagement.

There are a numerous views on what exactly defines patient engagement. Broadly speaking, patient engagement is defined as the degree to which patients are involved in their own care. A generally accepted, comprehensive definition provided by HIMSS Analytics states “An organization’s strategy to get patients involved in actively and knowledgeably managing their own health and wellness and that of family members and others for whom they have responsibility. This includes reviewing and managing care records, learning about conditions, adopting healthy behaviors, making informed healthcare purchases, and interacting with care providers as a partner.1 Essentially, patient engagement refers to the tools and technologies healthcare organizations use to engage patients before or after acute episodes of care and during the time between in-person visits.

The time between visits is a particular challenge in patient engagement. During provider-patient visits, discussions with care providers and increased involvement with the patient tends to lead to higher levels of engagement. As months pass after visits, active participation is no longer necessary and engagement becomes less of a priority. The result is often forgotten instructions provided during the visit. The effectiveness of continuous engagement with patients after their treatment was tested with a program that delivered text messages three days a week to 700 gastroenterology patients who were trying to lose weight during a six month period from November 2012 to April 2013. The objective was to analyze the effectiveness of prolonged engagement by comparing the success of the treatment between those who received texts and remained engaged with a control group who was left alone. The results showed that patients who received the text messages dropped 0.5 more on the Body Mass Index (BMI) than patients who did not participate.2 This simple example of increased communication depicts the drastic impact that engagement can have on the patient’s long-term, perceived value of the treatment and instructions given.

The ability to remain in contact with patients through text messaging is an example of how changes in technology offer new opportunities to increase patient engagement. Yet, despite numerous new systems used today, raising patient engagement remains a challenge. In part, this is due to the complexity and scope of effective long-term engagement. According to Dan Housman, Director at Deloitte, the biggest challenges of the historically accepted model of provider and patient relationships stem from assumptions which fail to account for the uniqueness of the individuals involved. These assumptions include that a patient must be obedient and that a physician should act with authority.3 This way of thinking undermines patient-centricity and fails to develop a healthy relationship which promotes patient engagement. By addressing the flaws in the traditional model and revising those to better reflect trending patient-focused values, healthcare providers can more effective communicate the value of continued patient engagement, which ultimately results in its increase.

IBM Watson Health is an example of one of the countless companies in healthcare making efforts to change this model and enhance patient engagement initiatives. This September, they launched a population health program, expanding their online cloud capabilities to provide a more accessible, relevant platform for accessing industry-specific trends and innovations. It is staffed with a team of professionals that engage with users, answering any questions very quickly. This results in more informed patients and addresses the issues with the assumptions in the traditional provider-patient relationship model. Furthermore, the program promotes and records user feedback on treatment which can be used to further improve the methods of care and provide tangible results in healthcare outcomes. Michael Rhodin, Senior Vice President of IBM Watson Group, stated in a press release “This newest expansion of the IBM Watson Health Cloud makes it an even more robust and flexible platform for the life sciences and healthcare industries and explains its rapid adoption among leading organizations in these fields.4 The value added to the interaction helps to promote further patient engagement over time.

Patient engagement is an important aspect the healthcare. It leads to better health outcomes for patients by increasing their understanding of the value in instructions from providers and promotes adhering to suggested preventative measures. Healthcare providers must continuously reach out to patients, keeping them motivated and increasing both parties understanding of the other. CHI will be further exploring patient engagement and its challenges in today’s dynamic healthcare industry at its upcoming Healthcare Executive Roundtable on October 15, 2015 in Manhattan. For more information, please visit http://www.chisite.org/education/healthcare-executive-roundtable.

References

  1. Noteboom, Michelle Ronan. “From Patient Engagement to Telehealth, What Does It All Mean?” Healthcare   IT News. 18 Sept. 2015. Web. 2 Oct. 2015
  2. Fellows, Jacqueline. “Meeting the Challenge of Patient Engagement.” HealthLeaders Media. 26 Aug. 2015. Web. 2 Oct. 2015
  3. Gruessner,Vera. “What Obstacles Stand in the Way of Patient Engagement? ” MHealth Intelligence. 16 Sept. 2015. Web. 2 Oct. 2015
  4. Gruessner, Vera. “Could a Population Health System Improve Patient Engagement?” MHealth Intelligence. 14 Sept. 2015. Web. 2 Oct. 2015.

How Do You Define and Measure Patient Experience?

By | Healthcare Quality, Healthcare Value, Patient Engagement, Patient-Driven Healthcare, Patients | No Comments

Happy senior citizen having a casual small talk with the friendly doctor

In today’s dynamic healthcare industry, with fundamental policy changes and ground-breaking technological advances occurring more than ever, it is vital to reevaluate the metrics used in determining the quality of care given to patients. Determining and measuring healthcare quality is a multi-faceted challenge, which must consider all aspects of care from patient treatment to administration and policy. The patient experience is among the core metrics used today, which is considered the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.1 The continuum of care considers every step in the healthcare process from arrival to outcome. As trending healthcare values continuously place a heavier focus around patient-centricity in all aspects of care, accurately measuring the patient experience is increasingly vital. This begins with addressing value discrepancies between provider and patient perspectives, assessing limitations in traditional data gathering methods, and better understanding patient standards of evaluation. A higher level of patient experience has shown yield direct benefits in long-term recovery, compliance with recommended treatment, and many other care outcomes dependent on trust and acceptance from the patient.2

The patient experience is influenced heavily by the culture and policies set by the provider. Whether a county hospital or day clinic, the success of various patient-centric initiatives and, in turn, impact of the overall atmosphere determined by administrators contributes directly into how personnel view and interact with patients. Yet these are a reflection of the staff’s values, which are not necessarily aligned with the values of the patients they treat.3 Therefore, it is imperative to give proper consideration to patients’ perspectives. The healthcare industry’s recent policy changes reflect this ever-growing necessity by offering new reimbursement programs for providers based on metrics that evaluate the patient experience.4 Yet, policy changes at the top can take a long time to trickle down and to patients. By continuously working to understand the difference between the patient’s and provider’s perspective, and its value in relation to patient experience, all healthcare providers can begin to bridge the gap by providing a higher quality level of care that is focused on the patient’s needs.

Understanding the value of the patient’s perspective in the quality of healthcare is limited to the effectiveness of the means used to gather the data. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey stands as the current standard in gathering data on patient experience. However, the data gathered is greatly dependent upon the level of patient satisfaction; which, while important, does not consider all the elements of the continuum such as quality, safety, and service outcomes.5 This results in a skewed assessment of the current level of patient experience and leads to new initiatives and corrective actions that do not properly address the needs of the patient. To address this disconnect, providers are encouraged to create patient advisory councils that add power to the voice of the patients, adjust CAHPS analysis techniques to account for known limitations, and increase the frequency of leadership rounds that prompt patient interaction.6 These suggestions are based on current efforts that have been implemented based on patient-centricity and represent just a few of the countless possibilities.

Regardless of the accuracy of the data gathered, properly evaluating the level of the patient experience requires understanding what quality of care is to the patient. An extensive research initiative in 2014, led by the Patient Experience Journal, highlighted six key performance indicators patients used when assessing the quality of their care. These were the level of provider participation in care, staff courtesy, self-reported health status, staff follow-up, waiting, and medical explanations.7 Based on these findings, it is apparent that patients place a much higher value on interpersonal interaction than the provider. This is understandable considering the limited knowledge they often possess regarding healthcare services coupled with stress and anxiety that come with health issues. Given an a greater appreciation of these key performance indicators used by patients in evaluating their experience, researchers can better differentiate between patient experience and patient satisfaction while properly aligning efforts to reflect a more accurate picture of patient values.

As the healthcare industry continues to drastically evolve, the challenge of effectively keeping the focus on the patient has grown equally complex. Factors and metrics long since accepted as industry standards have come into question at the same time that industry innovation has created entire new directions to consider. Regardless, the patient experience remains as important as ever. It serves as an essential gauge of quality, that when properly managed, can have profound effects on long-term recovery, patient follow-through, and overall care success. CHI will be further exploring the issues and values associated with the patient experience and many other related topics at our upcoming Healthcare Executive Roundtable on October 15, 2015 in Manhattan. The Roundtable will discuss what patient-centric healthcare value means in the 21st century. This consumer-focused Roundtable Discussion brings the best and brightest healthcare leaders from around the globe together to share their ideas and expertise on the intersection of healthcare value and patient-centricity. Please visit chisite.org/education/healthcare-executive-roundtable for more information.

References

  1. The Beryl Institute. “Defining Patient Experience.” The Beryl Institute. 28 Sept. 2015.
  2. Beattie, Michelle, Douglas J. Murphy, and Iain Atherton. “Instruments to Measure Patient Experience of Healthcare Quality in Hospitals: A Systematic Review.” National Center for Biotechnology. US National Library of Medicine National Institutes of Health, 23 July 2015. Web. 28 Sept. 2015.
  3. Brown, Claire R. “Where are the Patients in the Quality of Health Care?” International Journal for Quality in Health Care3 (2007): 125-26. Oxford University Press. Web. 28 Sept. 2015.
  4. “Consumer Assessment of Healthcare Providers & Systems (CAHPS).” Centers for Medicare & Medicaid Services. 8 June 2015. Web. 28 Sept. 2015.
  5. Wolf, Jason A. “Patient Experience, Satisfaction Not One and the Same.” Hospital Impact. 24 July 2014. Web. 28 Sept. 2015.
  6. Merlino, James I., and Ananth Raman. “Understanding the Drivers of the Patient Experience.” Harvard Business Review. 17 Sept. 2013. Web. 28 Sept. 2015.
  7. Van De Ven, Andrew H. “What Matters Most to Patients? Participative Provider Care and Staff Courtesy.” Patient Experience Journal1 (2014): 131-39. Print.

Drug Pricing Debate Heats Up as Turing Pharma Raises Price 5,000%

By | Drug Costs, Health Insurance, Healthcare Providers, Rising Cost | No Comments

9:30

Drug pricing continues to be a prevalent issue affecting many Americans’ daily lives. In fact, high drug costs are one of the most important issues affecting Americans. This issue recently made headlines after Turing Pharmaceuticals acquired the rights of Daraprim and raised prices from $13.50 a tablet to $750 overnight. That’s a 5,000% increase – Imagine if the price of a $4 gallon of gasoline rose to $222 per gallon. Daraprim is used to treat a parasitic infection called toxoplasmosis that can be life-threatening for people with weakened immune systems like newborns and those with cancer or AIDS. The drug has been on the market and approved by the FDA since 1953, so many are outraged that, after six decades, a drug price suddenly surges more than 5,000%. Even with insurance, people could be paying around $150 per pill, according to the HIV Medicine Association.

Two Democrat presidential hopefuls, Bernie Sanders and Hillary Clinton, both expressed outrage over this sharp drug price hike and have proposed plans to reduce drug costs and to prevent seemingly drastic arbitrary drug price increases if elected.  Sanders drew Turing into an ongoing congressional investigation of drug price increases as Daraprim is not an isolated case of drug price spikes. Sanders along with his colleague, Elijah E. Cummings, stated that “Americans should not have to live in fear that they will die or go bankrupt because they cannot afford to take the life-saving medication they need.” Clinton echoed this sentiment by stating, “nobody in America should have to choose between buying their medicine and paying their rent.” Even industry representatives showed outrage.  In what was perhaps one of the most stinging criticisms, John J. Castellani, President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry’s trade group, disavowed the company and Shkreli.  “PhRMA typically does not comment on matters related to individual company products or product pricing decisions,” he said in a statement. But, “Turing Pharmaceutical is not a member of PhRMA and we do not embrace either their recent actions or the conduct of their CEO.”

Turing CEO Martin Shkreli defended the new pricing of the drug by stating that the increase in revenue will be used to further research treatments for toxoplasmosis with fewer side effects, as well as allowing the company to invest in marketing and education to raise awareness of the disease. “This isn’t the greedy drug company trying to gouge patients, it is us trying to stay in business. This is still one of the smallest pharmaceutical products in the world,” he said. “It really doesn’t make sense to get any criticism for this.” He went on to say that Daraprim only has about an 80% success rate for treating toxoplasmosis, with also some possible toxic side effects. With increased funding for research and development, he believes that Turing can make a better drug with a higher success rate.  He went on to argue in an interview with CBS News that there “hasn’t been one pharmaceutical company focused on [the disease] for 70 years,” and this increase in funding will help the company dedicate itself to finding a cure to toxoplasmosis. He further stated that it would be losing money if it didn’t raise the drug price and now at the current price they are making “a reasonable profit, not excessive at all.”

Other professionals in the industry vehemently disagree. “Patients shouldn’t be taxed and charged for future research and development. Patients should pay for the drug they’re getting and what they need in the situation that they are” Oncologist Dr. David Agus said. He further added that “it’s predatory practice and it’s inappropriate.”

Shkreli emphasized the importance of the profitability success of his drug company which can be applied to other companies as well. “There’s no doubt, I’m a capitalist. I’m trying to create a big drug company, a successful drug company, a profitable drug company,” he said. “We’re trying to flourish, but we’re also — our first and primary stakeholders are patients, there’s no doubt about that.” However, the NASDAQ biotech index went down 4.41 percent on Monday September, 21st after headlines regarding this issue spread.

Questions of how the patients using the life-saving drug before or new users can obtain it if they cannot afford the new prices were prevalent immediately following Shkreli’s decision. After facing backlash, Shkreli made an announcement that if someone cannot afford the drug, the company will “give it away totally for free,” according to Bloomberg. He went on to state that the company would not deny someone a drug based on their inability to pay for it.

Dr. Judith Aberg, Chief of the Division of Infectious Diseases at Mount Sinai, raised concerns that hospitals may find the drug too expensive now after the price increase to keep in stock, which could result in treatment delays. She went further to say that “this seems to be all profit-driven for somebody and I just think it’s a very dangerous process.”

The case of Turing demonstrates that drug pricing still remains a hot bed issue. In December 2013, the FDA approved a new drug, Sofosbuvir, for the treatment of Chronic Hepatitis C.  The drug, commonly known as Sovaldi, was developed by Gilead Sciences, a U.S. biotechnology company.  The initial price tag of a 12-week treatment of Sovaldi was reported as approximately $84,000, or nearly $1,000 per pill.  This resulted in considerable media attention and an ensuing pricing controversy.  Editorials and op-eds sprung up around the country debating Sovaldi’s price tag and the broader debate over fair drug pricing.  Some politicians expressed outrage over the cost of new drugs, while others argued for free market pricing and rewards for the considerable R&D costs that biopharmaceutical companies incur when bringing a new drug to market.  The often niche drug pricing debate had officially spilled over into the mainstream conversation.  Payers, policymakers, pharma, patients, and providers all voiced strong— and sometimes contrasting— opinions.

To be sure, the issue of drug pricing is a hotbed issue that won’t go away anytime soon.

Patient-Focused Healthcare Trends

By | Uncategorized | No Comments

A little girl at the doctors office sitting on the examining table with a doctor checking her heartbeat with a stethascope with a nurse in the background.

The patient-centric era of healthcare is not only possible – it’s happening now, as the landscape shifts towards a consumer-driven model of care delivery.  Recent examples are abound.

For instance, Novant Health, a leading healthcare provider with 15 hospitals and more than 350 physician practices, started an electronic medical records project called Dimensions in July 2011.  Later in May 2013, Novant began providing email visits and video visits with patients via MyChart, an electronic health records portal for nonemergency health issues.(1) Patients can interface with their physicians through computers and mobile devices.  This program substantially increased the efficiency and quality of healthcare.  Patients without emergency situations no longer needed to wait for appointments and pay high bills for treatments and medications. The integration of digital technologies is a breakthrough that enhances patients’ experiences.

In another case, Wake Forest Baptist also started to offer video visits in May for its 25,000 employees and their families.  Dr. Richard W. Lord, Wake Forest Baptist’s chairman of Family and Community Medicine, states, “There are a limit number of things that are allowed to be done through some of these platforms for video visits. So we wanted to go ahead and get that out and get it started so we could understand the demand for these types of video visits”(2).  These e-visits are redefining the patient-provider interface by reducing overall costs that are passed on to patients, and thus maximizing overall healthcare value for patients.

Additionally, the pharmaceutical industry is also starting to shift its marketing strategy from products to patients. Today’s increasingly well-informed patients are more involved in the processes of selecting and switching therapies.  This paradigm shift drives industry to increasingly focus on patients.  Marketers have already learned that it is essential to educate, communicate, and engage patients throughout their experiences with a disease. (3) They not only need to provide the highest quality of healthcare products for patients, but they also must focus on enhancing patients’ experience with their products throughout the entire therapeutic process.

To make medical research more patient-centric, top journals such as British Medical Journal, Research Engagement and Involvement, and Journal of Participatory Medicine recently introduced patient reviewers.  This trend gives patients a platform and opportunity to speak about their experiences. Patient involvement in all aspects of healthcare is to be welcomed, and patient perspective can play a much larger role in the development of future healthcare product and services.(4)

These are just a few of the many examples of the trend toward focusing on patient experiences and maximizing healthcare value for patients. CHI’s Healthcare Executive Roundtable will further discuss what patient-centric healthcare value means in the 21st century. This consumer-focused Roundtable Discussion brings the best and brightest healthcare leaders from around the globe together to share their ideas and expertise on the intersection of healthcare value and patient-centricity.  Please visit chisite.org/education/healthcare-executive-roundtable for more information.

References

  1. http://www.journalnow.com/business/business_news/local/local-healthcare-providers-offer-video-doctor-visits/article_b64176f1-f67f-5849-a546-832149a39080.html
  2. http://www.journalnow.com/business/business_news/local/local-healthcare-providers-offer-video-doctor-visits/article_b64176f1-f67f-5849-a546-832149a39080.html
  3. http://www.prnewswire.com/news-releases/consumers-forcing-pharmaceutical-industry-to-shift-its-marketing-focus-from-products-to-patients-300122018.html
  4. http://timesofindia.indiatimes.com/india/Patients-can-contribute-to-medical-studies-now/articleshow/48536349.cms

ACOs and the Affordable Care Act

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The transition period from any old, familiar system to a new one is difficult. Providers, pharma, patients, payers, and policymakers on all sides of the healthcare industry have encountered hurdles originating from the transition from the old and inefficient healthcare system to the new system born from the Affordable Care Act (ACA). Accountable Care Organizations (ACOs) were designed for healthcare organizations and providers that are already experienced in coordinating care for patients across care settings(1) and to help these providers transition from the past fee-for-service model to the new value-based healthcare model.

The ACA aims to provide healthcare for the U.S. population through expansion of public and private insurance coverage, coverage mandates, subsidies, and creation of insurance exchanges(2). But, in order to do so, the American healthcare system must transition from the fee-for-service model to the value-based model. The fee-for-service-model is an approach to healthcare in which providers are paid for each service (i.e. an office visit, test, or procedure)(3), whereas the value-based model is an approach in which a portion of the provider’s (i.e. hospitals, providers etc.) potential payment is tied to a provider’s performance on cost-efficiency and quality performance measures. While providers may still be paid fee-for-service for a portion of their payments, they may also be paid a bonus or have payments withheld. For value-based contracts, this bonus is not paid unless the provider meets cost efficiency and/or quality targets(4). The new model is now more patient-centric and the previous implicit and explicit costs, which previously fell on the patients, now fall on the providers of healthcare.

The implicit price, or the non-financial costs of transitioning, a challenge facing the ACA, is derived from incentives. Prior to the ACA legislation, the private insurance market allowed patients, providers, and payers to select the best fit for one another. This was a major component of the fee-for service-model. Patients had the incentive to stay healthy, so they did not have to pay money to the providers for treatment (this excludes the cost of medication, etc.). Providers had the incentive to treat as many patients as possible and order more tests to boost their incomes.

However, with the new value-based model, the incentives are shifted. Under the new value-based model, providers have the incentive to keep patients healthier. In fact, providers would prefer to treat only the healthy patients as providers are reimbursed with a set amount. This set amount comes from the ACOs, per patient, based on the old fee-for-service basis(5). Thus, providers want to treat healthy patients to maximize their revenues. Alternatively, the more patients a hospital or member of an ACO treats, the more the entity can counterbalance its revenue loss. Likewise, there is power that comes from belonging to an ACO: The ACO can earn extra revenue through gain sharing, sharing of savings resulting from collaborative efforts to provide care cost-effectively, with Medicare if the overall costs of care for the beneficiaries attributed to it are lower than predicted. This only applies if the ACO also meets stringent conditions of governance (clinicians, not insurers, run them), transparency, and quality performance.(6)

But, much like privatization, this leads to the problem of most providers not wanting to take on the costs of caring for the unhealthy portion of the population. The government purposely created ACOs to address such problems with the ACA. This is why ACOs are a necessary tool to help transition from the old to new model to counterbalance this incentive side-effect.

ACOs are groups of medical providers (i.e. physicians, hospitals, insurance companies) that accept payments based on quality under the Medicare Shared Savings Program (MSSP).(7) They were created in part by the ACA to aid hospitals and providers in providing value-based healthcare treatment. If providers do not spend all the money of the allotted subsidiary, then they are permitted to keep that extra revenue. However, if not, then the ACOs can owe money to Medicare.

Another reason why ACOs are crucial to a smooth transition from the new to old models results from the payment models, which cannot be separated from changes in care delivery. They require increasingly tight hospital-physician alignment, which can be achieved through physician employment, entering into service line co-management arrangements, clinical integration, or other methods. Thus, to operate effectively, there must be better communication and fewer occurrences of asymmetrical information under the value-based model in order to provide the best quality of healthcare possible throughout the transition.

Although hospitals are required to keep track of the number of patients treated for certain physical ailments under the ACA, all hospitals participating in ACOs are required to supply additional metrics to improve clarity. For example, the ACA will require Medicare ACOs to report 33 different quality metrics.(8) This, along with other incentives to keep better track of patient records and become more organized, helps improve clarity and transparency of the healthcare system.(9) Hospitals will have to become very efficient and become very familiar with their cost structure in order to reduce costs as the losses have now shifted from the patient to the ACO infrastructure. With this clarity, it will be easier for consumers, producers, and the government to track changes, learn from mistakes, correct tweaks, and smooth the transition from the past model to the value-based model.

In the end, there appears to be both pros and cons to ACOs as a method of helping the providers, pharma, patients, payers, and policymakers transition from one model to another. With proper implementation, time, and further research, the Affordable Care Act will be improved so it can improve the quality of healthcare for all Americans.

However, a new problem with ACOs has not been addressed yet: How will this affect the patient-centric value-based model? The Center for Healthcare Innovation’s Healthcare Executive Roundtable on October 15, 2015 will address new questions in this uncertain transition period. This consumer-focused Roundtable Discussion brings the best and brightest healthcare leaders from around the globe together to share their ideas and expertise on the intersection of healthcare value and patient-centricity.  Please visit http://www.chisite.org/events/healthcareValueRoundtable for more information.

References

  1. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26.html
  2.  https://en.wikipedia.org/wiki/Accountable_care_organization#In_the_Affordable_Care_Act
  3. http://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/fee-for-service.html
  4. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB0QFjAAahUKEwienIGUuvzHAhVMEZIKHXyvBes&url=http%3A%2F%2Fconsultant.uhc.com%2Fassets%2Fvbc_overview_flier.pdf&usg=AFQjCNEN-MYB3U7OdqU8OSch5T5HZXZNYg&bvm=bv.102829193,d.aWw&cad=rja
  5. https://www.healthcatalyst.com/hospital-transitioning-fee-for-service-value-based-reimbursements
  6. http://www.fiercehealthcare.com/story/will-acos-show-financial-returns/2012-01-23
  7. http://www.hhs.gov/news/press/2014pres/09/20140916a.html
  8. http://www.wsj.com/articles/SB10001424052970204720204577128901714576054
  9. http://www.wsj.com/articles/SB10001424052970204720204577128901714576054

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