Interviews

The value discussion in healthcare is becoming more relevant as the healthcare system increases its focus on better outcomes, said Stephen Grubbs, MD, vice president for clinical affairs at the American Society for Clinical Oncology.

Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum, explained that one’s opinion of quality measures comes from the type of work they are in — while a primary care physician may think there are too many, a health plan could believe there’s not enough. The challenge then, she added, is filling these gaps by creating and testing new, outcome-driven measures.

Specialty pharmacy may be one of the most rapidly rising costs in all of healthcare, but these costs are shouldered by a small percentage of patients. As such, it is essential that new innovative payment models be developed for these new products, said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, said that quality measurement is at the core of transitioning to value-based payment, and that the initiative can’t truly move forward without putting the work in to identify and define what that value is.

Sustainability in the Affordable Care Act marketplaces will occur when the health plans and the providers come together to establish both cost and quality goals and work together to achieve them, explained Karen Ignagni, president and CEO of EmblemHealth.

Although the term "accountable care organization" (ACO) may not be here to stay, value-based organizations are here to stay based on the direction CMS is headed, said Jeb Dunkelberger, vice president of accountable care services at McKesson and clinical & commercial operations at ACO Partner.

There are desirable and undesirable effects of high-deductible health plans, and the use of value-based insurance design may mitigate adverse effects of these plans, explained Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Orphan drugs are a very lucrative business, and Aimee Tharaldson, PharmD, senior clinical consultant of emerging therapies at Express Scripts, expects to see more orphan drugs reach market as manufacturers focus their development efforts in these areas.

The United States is closer than it has ever been to considering a single-payer health system. Patricia Salber, MD, MBA, of The Doctor Weighs In, discusses how a single-payer system economically makes sense.

Although cancer care costs are rising, it is proportional to the total utilization of healthcare resources and spending growth is happening more in areas that have seen innovation, explained Debra Patt, MD, MPH, MBA, director of public policy at Texas Oncology.

With the development of Kaiser Permanente’s new medical school comes an emerging philosophy to more directly align medical education with the industry’s current transition to more integrated, holistic approaches to care, said Bernard J. Tyson, chairman and CEO of Kaiser Permanente.

Incorporating big data is essential as it can help explain failures in medical practice, accumulate patient information, and perform a variety of other useful functions, explained Lonny Reisman, MD, CEO of HealthReveal.

While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that fair and transparent benchmarks are important in creating successful ACO programs.

While some insurers are questioning the sustainability of the Affordable Care Act health insurance markets, Erica Hutchins Coe, partner and co-leader of Center for US Health System Reform at McKinsey & Company, said that carriers continue to see new entrants on their exchanges, which she believes makes for a promising future.

Though the implementation of the Affordable Care Act has introduced various beneficial provisions for the American public, Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, said that he still sees room for improvement.

A statewide all-payer claims database would permit more insight into what’s happening with cost and quality of providers, and possibly transform healthcare payment, explained Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

Jay Sheehy, senior vice president of product innovation at EmblemHealth, explained that being able to tailor your message to specific patient populations will help to better engage consumers, which will prove to be more successful for healthcare companies in the long term.

One of the biggest concerns Farzad Mostashari, MD, chief executive officer of Aledade, has about accountable care organizations, is that they are going to experience backlash similar to what managed care has received in the past.

While discussion of value frameworks has grown in academic and policy meeting settings, physician education on the subject is still in its very early stages, said Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review.

According to Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine, payers and pharmacy benefit managers can aid in patient access to the medication they need to treat addictive disease by ensuring an evidence-based prior authorization protocol, just as they would for a patient with a chronic disease.

Michael Kolodziej, MD, national medical director for oncology strategy at Aetna, said that the evaluation of academic medical centers has allowed the company to examine what lies at the heart of creating optimal patient outcomes and experiences.

The key in developing core sets of quality measures is looking at coordination of care, cost of care, and quality of care, as methods that all work simultaneously together, explained Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. However, she added that creating a small amount of measures centered upon core conditions and directly tied to outcomes is far more beneficial than creating a hundred new measures.

Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at America’s Health Insurance Plans (AHIP), explained that CMS and AHIP’s recent release of set core quality measures was an effort to help harmonize the varying types of measures that already exist as well as to focus in on quality improvement efforts.

According to Alan Balch, PhD, CEO of the Patient Advocate Foundation, having a common language that is centered on the patient is crucial when stakeholders come together with various value frameworks. Ultimately, he said it’s these value frameworks that are going to steer the patients in one way or another.

The last 6 months have been considered by many as a historic moment for interventions that focus on the social needs of patients, explained Rocco Perla, president of Health Leads.

For as much as penalty programs for hospital readmissions have created challenges, they’ve also created awareness, said Stephen Rosenthal, chief operating officer of The Care Management Company at Montefiore Medical Center.

It is important that health insurers fully understand the populations and demographics they are working with in order to effectively engage their consumers, said Jay Sheehy, senior vice president of product innovation at EmblemHealth.

More insurers are moving towards alternative payment and delivery models, but the transition needs to happen a lot quicker, explained Michael E. Chernew, PhD, during a panel discussion at the ACO & Emerging Healthcare Delivery Coalition Spring Live Meeting.