Interviews

Although there are innovative ideas from drug manufacturers and pharmacy benefit managers (PBMs) about improving medication adherence, no one wants to get into legal trouble to implement them, said Lauren Harner, JD, senior manager of policy at PhRMA.

Pathways are still a young enterprise so barriers to their adoption are being more readily recognized than the number of problems being solved are, according to Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Managed care will become rapidly refined and driven toward more patient-reported outcomes in the future, said Christine K. Cassel, MD, president and chief executive officer of National Quality Forum.

With new treatments helping patients with cancer to live longer, healthcare providers now have new issues of long-term survivorship to consider, said Joseph Alvarnas, MD, the editor-in-chief of Evidence-Based Oncology.

The digitization of health will help to identify patients when they're most vulnerable and present new opportunities to change the trajectory of their disease before they suffer avoidable consequences associated with chronic disease, said Lonny Reisman, MD.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

The American Journal of Managed Care (AJMC) is the first and greatest source of managed care information and research, said Julie Slezak, MS, chief analytics officer at CareCore National and an editorial board member for AJMC.

The use of genetic testing has led to a radical change within certain specialties and hospital departments. And although doctors are being asked to do more, they do it gladly because the work leads to better treatment decisions for patients, said Mark G. Kris, MD, William and Joy Ruane chair in thoracic oncology at Memorial Sloan Kettering Cancer Center.

With the goal of accountable care organizations and population health being patient centric, it is important that stakeholders involved in the care of the patient develop partnerships to deliver high-quality care in a cost-effective manner, explained René Lere, MD, president of Florida Blue and GuideWell.

Although patients are being asked to pay more when it comes to their healthcare, the concept of having more "skin in the game" is misguided when it comes to healthcare, according to Elise Gould, PhD, senior economist and director of health policy research at the Economic Policy Institute.

The healthcare system in the US makes it nearly impossible for patients and physicians to form a real relationship, and patients are rarely asked about what's going on in their lives, which could inform treatment, said Marc Boutin, JD, chief executive officer of the National Health Council.

David Blumenthal, MD, MPP, president of The Commonwealth Fund, believes that managed care has lost some of its focus and he would like to see more attention paid to holistic management of care for the frailest, sickest patients.

Palliative care should enter into the discussion with patients with cancer as early as possible as it can manage symptoms from therapy or it can provide comfort to patients who cannot afford or choose to forgo therapy, said Amy Davidoff, PhD, MS. Plus, she discusses the impact biosimilars may have on therapy costs.

Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.

The earlier you intervene with patients with mental health issues, the better the outcome for both the individual and the health system. Early intervention prevents pain and suffering and actually saves costs in the long run, said John Santopietro, MD, chief clinical officer of behavioral health at Carolinas HealthCare System.

One of the biggest challenges with measuring primary medication nonadherence is coming up with a definition for it in the first place.

Julie Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology and keynote speaker at Patient-Centered Oncology Care 2015, explains the importance of the meeting and how patients benefit when a diverse set of stakeholders come together in one room.

Lonny Reisman, MD, chief executive officer of HealthReveal, has a long history with The American Journal of Managed Care and its co-editors-in-chief A. Mark Fendrick, MD, and Michael E. Chernew, PhD, and said he is grateful for the work the journal has done over the years.

With pay-for-performance evolving from the "check-the-box" model, providers need to learn to work within teams that can understand these new programs, explained Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

The real-world evidence being published in The American Journal of Managed Care has made the journal the most important journal for payers to read, according to Dana Goldman, PhD.

Elise Berliner, PhD, director of the Technology Assessment Program in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality, explains how the agency is using horizon scanning to peer into the future of treatments.

The next 20 years will bring greater use of big data and health information technology in managed care, but the challenge is using that technology to place patients in charge of their own healthcare, said Rajesh Balkrishnan, PhD, associate director for research and education at the University of Michigan Center for Global Health.

Although primary care is important, it may not be the center of the care model for patients with chronic diseases, like type 2 diabetes, and these providers are usually just a part of a larger ecosystem of providers, said Andrew Pumerantz, DO, FACP.

As the National Comprehensive Cancer Network (NCCN) celebrates 20 years, Clifford Goodman, PhD, takes a look at how NCCN will evolve after another 20 years, including constant streaming of real-time data and more patient involvement.

As the United States looks to reform its healthcare system to provide better value at lower costs, the real challenge is innovating at scale across the country, said Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Over the years, the research published by The American Journal of Managed Care has been key in understanding the link between value and outcomes and what is paid for healthcare services, said Charles N. Kahn III, MPH, president and CEO of the Federation of American Hospitals.

Although cost-effectiveness analysis has not been a formal part of cardiology clinical guidelines until recently, it has "always been the elephant in the room," said Mark Hlatky, MD, professor of health research and policy and professor of cardiovascular medicine at Stanford University.

As CMS moves to value-based payments, having good measures of value that payers and providers trust will be critical, explained Stuart Guterman, senior scholar in residence AcademyHealth.