Interviews

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.

Given how much technology will evolve over the next 20 years, predicting the future of healthcare is almost impossible, but Margaret O'Kane, MHA, president of the National Committee for Quality Assurance, expects big things from telemedicine and predicts new investigations in motivating patients to take control of their own wellness.

Current care areas with gaps in measurement and the next generation of performance measures, according to Rebecca Snead, RPh, executive vice president and chief executive officer of the National Alliance of State Pharmacy Associations and a member of the board of directors for the Pharmacy Quality Alliance.

The ability to charge increasingly higher prices for drugs that already have competition on the market is stifling innovation and wasting resources and human subjects, according to Peter Bach, MD, MAPP, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes.

Healthcare practitioners are well aware that the rising cost of medical advances may affect their ability to deliver great care to all their patients, but there are ways they can address the issue, said Joseph Alvarnas, MD, the editor-in-chief of Evidence-Based Oncology.

Jan Berger, MD, MJ, wishes The American Journal of Managed Care a happy 20th anniversary and looks forward to another 20 years, plus she looks forward to the 20th anniversary of sister publication The American Journal of Pharmacy Benefits, of which Dr Berger is the editor-in-chief.

Kim Thiboldeaux, chief executive officer of the Cancer Support Community, discusses the importance of providing strong community support, the misconceptions of clinical trials, and creating a tailored care plan.

There are a couple of health information technology challenges facing new accountable care organizations that are bringing together different entities with disparate systems that need to learn to work together, explained Scott Berkowitz, MD, MBA.

At Community Care of North Carolina, there is not only a focus on global performance metrics, but also the programs and metrics that will contribute to improving those global outcomes metrics, explained Troy Trygstad, PharmD, MBA, PhD, vice president of pharmacy programs at Community Care of North Carolina.

The first year to 18 months of an accountable care organization (ACO) is the most challenging as data begins to trickle in of everywhere a patient went to get care, and healthcare providers typically aren't taught how to utilize that information, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

For individuals who have not made the sort of risk-averse decisions in their lives that lead to better jobs and wealth accumulation, making treatment decisions after a cancer diagnosis can be very difficult, said Amy Davidoff, PhD, MS, senior research scientist in public health at the Yale School of Public Health

A survey of groups using and developing clinical pathways revealed 7 distinct themes that highlight how these pathways are created and used, and the challenges and barriers to creating new pathways, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

The concept of the value of new breakthrough therapies has become disconnected from the actual cost of them, but there are ways to better align the benefits and costs of treatments, according to Darius Lakdawalla, PhD, Quintiles Chair in Pharmaceutical Development and Regulatory Innovation at the University of Southern California Sol Price School of Public Policy.

When treatments get in the marketplace and are being recommended and used, there are actually still a lot of questions that can only be answered by researching real-world data, explained Joe V. Selby, MD, MPH, executive director of the Patient-Centered Outcomes Research Institute.

While it's exciting to see more and more physicians wanting to participate in clinical, they need a little background, support, and infrastructure to do so, said Robert Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

Sometimes patients are so concerned with being good patients that they simply agree to what the clinician has said without fully understanding, and it's important to ask questions and ensure their voices are heard, said Mary Lou Smith, MBA, co-founder of the Research Advocacy Network.

Only about one-fourth of all patients with behavioral health issues are diagnosed by a primary care provider and receive the appropriate treatment, said Paul Ciechanowski, MD, MPH.

Although hospital consolidation has not shown the benefits proponents had touted, it is inevitable that there will be consolidation in healthcare, because the environment is too challenging for smaller hospitals and many physician practices, explained Paul Ginsburg, PhD.

While the shift to cancer becoming more of a chronic disease does not have a huge change on the approach of the payer, there are some new challenges to address, said Jennifer Malin, MD, medical director for oncology at Anthem.

Patient engagement is in constant change and has evolved over the years into how care is delivered and how quality measures are developed, explained Marc Boutin, JD, chief executive officer

It's time for employers to consider more than just the medical benefits but the pharmacy benefits when it comes to specialty pharmaceuticals, said Cheryl Larson, BA, vice president of the Midwest Business Group on Health.

Restrictive prior authorization policies have made had a negative impact on schizophrenia patients, who tend to be an already-difficult population to treat, explained Dana Goldman, PhD.

The field of managed care has evolved greatly over the last 20 years, and The American Journal of Managed Care has kept those in the industry up to date with changes, said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation.

While health information technology can be a solution for primary medication nonadherence, it can also be burdensome, according to Lauren Harner, JD, senior manager of policy at PhRMA.