Results from the FOURIER trial have provided convincing data that there is no downside to aggressively lowering cholesterol with PCSK9 inhibitors, and studies have shown there are cardiovascular benefits associated with Repatha, but reimbursement remains challenging, said Eliot A. Brinton, MD, FAHA, FNLA, president of the Utah Lipid Center.
Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, discusses the impact of the group’s report, Medicaid 2.0, which outlined how the state can bring healthcare transformation principles to a program that consumes a fifth of the state budget. New Jersey elected a new governor in November, and the blueprint was widely seen a policy recommendation for the next administration.
A non-fasting test to measure low-density lipoprotein (LDL) cholesterol has many advantages for patients and physicians, but payers can also see some benefits, explained Eliot A. Brinton, MD, FAHA, FNLA, president of the Utah Lipid Center.
Diabetes prevention is about a change in lifestyle that will lead to internalized benefits that reduce risk, explained Paul Chew, MD, chief medical officer of Omada Health.
Real-world evidence isn't usually used for regulatory decisions, but the FDA is poised to start using it more, and there are challenges to using real-world data in clinical trials that will need to be navigated, said Nat Turner, co-founder and CEO of Flatiron Health.
As oncology moves toward more deep diagnostic testing and as standard of care continues to quickly evolve, technology advancements are necessary to continue to improve patient access to clinical trials, explained Amy Abernethy, MD, PhD, the chief medical officer, chief scientific officer, and senior vice president of oncology at Flatiron Health.
New approaches for measuring quality need to be developed to get frontline caregivers involved in the early stages of quality measure decisions, said Peter Aran, MD, medical director of population health management at Blue Cross Blue Shield of Oklahoma.
Aaron Lyss, director of value-based care for Tennessee Oncology, discusses the lessons that’s were learned after experiences with the Oncology Care Model.
Biosimilars for core therapeutics in cancer are starting to come out, and community oncologists need to understand what that means for their business, as well as what proposed policy changes could mean for reimbursement, explained Tesh Khullar,
With 30% to 40% of people in the workforce at risk for prediabetes, it is important for employers to embrace diabetes prevention in the workplace, said Paul Chew, MD, chief medical officer of Omada Health.
New Jersey is 1 of 3 states that will test a new set of metrics to assess how well new payment models have penetrated markets, explained Linda Schwimmer, JD, president and CEO of the New Jersey Health Care Quality Institute, which will lead the process in New Jersey.
Most practices are not ready to transition to the Medicare Access and CHIP Reauthorization Act (MACRA) payment models, although there is a leading group of practices that are more prepared to make the switch, said Aaron Lyss, director of value-based care for Tennessee Oncology.
Clinicians have some influence over social determinants that affect the health of patients, but it’s important for partnerships to be developed to further improve the negative impacts of certain determinants, said Charlie Fazio, MD, senior vice president and medical director of HealthPartners.
A practice must be prepared for any disruption of the electronic medical record, and have a plan in place, even if it doesn't occur often, saidTeri Kovach, RN, OCN, compliance officer and charge nurse at Salish Cancer Center.
While technology and electronic health records will one day be used in a variety of ways can help improve the delivery of care to patients, this may take a long time, said Bobby Green, MD, MSCE, senior vice president of clinical oncology at Flatiron Health.
Brian Marcotte, president and CEO of the National Business Group on Health, offers recommendations for employers that are considering accountable care organizations (ACOs) and describes situations when an ACO is not a good fit.
Very structured processes for vendor selection is necessary to improve outcome measurements and data analytics, explained Aaron Lyss, director of value-based care for Tennessee Oncology.
Cost will be one of the most important factors to determine whether or not a biosimilar pegfilgrastim improves patient access to the treatment, said Leora Horn, MD, clinical director of thoracic oncology at Vanderbilt-Ingraham Cancer Center, assistant vice chancellor for faculty development at Vanderbilt University Medical Center.
Value-based care will start to transition from being an option to being a requirement, and better data will be needed to improve how care is delivered to patients, said Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care.
Compared with the trial results of EUCLID and PEGASUS, the COMPASS trial advances the field of cardiovascular disease in combination therapies, said John Eikelboom, MD, of McMaster University.
As the healthcare industry tries to move away from fee-for-service, the new Scorecard being developed by Catalyst for Payment Reform will help states get a better understanding of whether or not new payment models are actually working, explained Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute.
Charlie Fazio, MD, senior vice president and medical director of HealthPartners discusses the uncertainty felt by practices as the industry moves from fee-for-service to value-based care.
Naiyer A. Rizvi, MD, director of thoracic oncology and immunotherapeutics at Columbia University Medical Center discusses the effectiveness of PD-1 antibodies in lung cancer.
Getting people on board when a new electronic health record (EHR) is being implemented is one of the biggest obstacles to overcome and is important for the success of the new EHR, said Teri Kovach, RN, OCN, compliance officer and charge nurse at Salish Cancer Center.
Technological advances will lead to improvements in clinical trials and greater participation in trials by patients, explained Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.
Payers and other organizations can help smaller practices develop the necessary infrastructure to complete their healthcare transformation, said Peter Aran, MD, medical director of population health management at Blue Cross Blue Shield of Oklahoma.
As the health system evolves it will become increasingly important that practices understand business, explained Tesh Khullar, senior vice president of provider solutions at Flatiron Health.
CMS’ decision to exclude digital health from its proposal for the Medicare Diabetes Prevention Program (DPP) has caused a controversy, explained Paul Chew, MD, chief medical officer of Omada Health.
There are 2 categories of challenges facing oncology practices as they transition to value-based payment models, said Aaron Lyss, director of value-based care for Tennessee Oncology.
Creating outside partnerships for community oncology practices is important because these partnerships move the industry towards value-based payment models, said Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care.
