Panel Discussion

Daniel F. Hayes, MD, discusses the FDA's announcement that it will begin to regulate laboratory-developed tests and his belief that it will not squash innovation in the field.

There are currently 2 ways diagnostic tests can make it to market in the US: either through the FDA or laboratory-developed tests. This dual-pathway situation has led to a "buyer beware" market, according to Daniel F. Hayes, MD.

Panel moderator Surabhi Dangi-Garimella, PhD, managing editor of AJMC's Evidence-Based series, starts the panel discussion with a discussion about how payers and physicians evaluate the value of a particular diagnostic test.

The panelists get to say their final remarks, and while they are all optimistic about the direction mental healthcare in the United States is heading, they all acknowledge the change is slow and more work is left to be done.

Over the long haul, Paul Gionfriddo expects that the Mental Health Parity Act will help rectify the situation where mental health professionals are paid so inadequately for the services, although in the short haul the effects are much more subtle.

The annual estimated cost of mental healthcare is $80-$100 billion in direct costs, but Paul Gionfreddo and Stuart Lustig, MD, both don't believe that any more cost savings can be realized by squeezing the back end of the system.

The panelists discuss the complications associated with patients who have mental health illnesses and are also suffering with other chronic conditions.

All medical illnesses have issues with nonadherence and part of the reason is because the American health system doesn't provide the right education, support, and close follow-up needed to get the right medicine to the right person, Wayne Katon, MD, said.

Wayne Katon, MD, addresses the concern of overdiagnosis in mental health, which results in an overuse of drugs like Prozac for people with minor depression. He attributed the problem to the fact that primary care physicians have difficulty getting people into the therapy they need and have to result to medications.

Wayne Katon, MD, describes the collaborative care model being implemented in the state of Washington, which is largely rural outside of Seattle. They are using a team-based approach to improve outcomes of people with mental health disorders who are coming into primary care systems.

Paul Gionfriddo and Stuart Lustig, MD, MPH, discuss access to care issues for mental health patients, in particular for children and young adults.

Wayne Katon, MD, started the discussion by highlighting the most common and prevalent mental health illnesses-anxiety and depression-and how the healthcare industry is failing to even properly care for these patients.

Surabhi Dangi-Garimella, PhD, managing editor of The American Journal of Managed Care's Evidence-Based series, led the discussion on mental health and barriers to care by first talking about access to care statistics in the United States.

The panelists offer their closing remarks regarding immuno-oncology's promises and challenges.

Michael Kolodziej, MD, considers the benefit of combination therapy vs sequential and whether the increased toxicity of combination therapy is worth it.

Although the oncolytic virus therapy being used in the OPTIM trial has been modified in a way that there should be minimal safety concerns, it should still be handled in a way to limit adverse effects and mutations, according to Kimberly Shafer-Weaver, PhD.

While it would be nice to think that one and only one therapy would be effective at combatting cancer, combination therapy is needed, Kimberly Shafer-Weaver, PhD, said.

People are now viewing cancer as a kind of chronic disease that can be held at bay, if it cannot be eliminated entirely, according to Kimberly Shafer-Weaver, PhD.

Although there are some efforts to marry progression-free survival benefits to clinical benefits defined by the patients, the approach is still in the early stages and needs to be moved forward more quickly, according to Michael Kolodziej, MD.

Michael Kolodziej, MD, explains, the benefit of using biomarkers from a payer perspective to ensure that the right patient gets the right treatment.

Although animal models have shown the anti-CTLA-4 antibodies boost the immune system, the human body is not so simple, Jianda Yuan, MD, PhD, said.

In this clip, Kimberly Shafer-Weaver, PhD, discusses specific biomarkers that could establish utilities for specific patient populations and measuring response to drugs.

Jianda Yuan, MD, PhD, explains the importance of bringing the latest innovations to the public and how more data are showing promising immunologic and clinical responses for different types of cancer.

Surabhi Dangi-Garimella, PhD, managing editor of The American Journal of Managed Care's Evidence-Based series led the panel of experts in a discussion on immuno-oncology by first talking about checkpoint inhibitors currently in the market and under development.

Panelists discussed the successes and failures associated with pathway implementation.

The panelists continued to discuss evidence-based medicine, as well as the incentives there might be to examine emerging and existing therapies or drugs.

In regard to updating pathways and guidelines, Dr Sonnad asked about the opportunity for newer, expensive immunotherapies to be included in a pre-determined pathway.

Panelists analyzed the concept of penalizing providers who deviate from pathway programs.