Payers

Panelists from a session at Asembia 2021 Specialty Pharmacy Summit in Las Vegas discussed considerations for manufacturers, specialty pharmacies, and payers entering the rare disease and gene therapy market.

Theresa Juday, RPh, director, Specialty Product Development, CVS Health, discusses how payer interest in the use of cognitive behavioral therapy for insomnia has grown in recent years.

Some policy reforms can help incentivize more use of value-based contracts, but overall an area that needs more work is value-based contracts with pharmaceutical companies, said Steven Peskin, MD, executive director, director of population health, Horizon Blue Cross Blue Shield of New Jersey.

Panelists of the opening session at Asembia 2021 Specialty Pharmacy Summit in Las Vegas address emerging shifts in specialty pharmacy, its impact on the health care system, and future implications post pandemic.

Horizon Blue Cross Blue Shield of New Jersey has been involved in a number of value-based cancer care initiatives that will be highlighted during an upcoming Asembia session, said Steven Peskin, MD, MBA, executive director, director of population health, Horizon Blue Cross Blue Shield of New Jersey.

Posters presented at the AMCP Nexus 2021 meeting reviewed the cost-effectiveness and cost per response for zanubrutinib vs ibrutinib.

The proposal to allow HHS to negotiate Medicare Part D drug prices is relatively realistic although the outcome will vary a lot drug by drug and class by class, said Melissa Andel, MPP, vice president of health policy at CommonHealth Solutions.

Physician and health policy advocates praised the emphasis on streamlining models and ending silos, but practices that invested in the Oncology Care Model (OCM) await key details.

Novel financial concepts will help to ensure sustainable access to gene and cell therapies, which may help reduce disparities, said Jane F. Barlow, MD, MPH, MBA, senior advisor, FoCUS Project, MIT Center for Biomedical Innovation, and executive vice president and chief clinical officer at Real Endpoints.

Nicole Herbst, MD, a pulmonary and critical care fellow, talks about how visitor restrictions and communication practices in intensive care units (ICUs) during the COVID-19 pandemic negatively impacted provider job satisfaction and were linked to job burnout, according to a survey presented at the CHEST Annual Meeting 2021.

The fall meeting has multiple sessions on different aspects of health disparities and addressing drug costs, including 3 sessions on biosimilars.

Periodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.

Achieving health equity will depend on the quality of huge volumes of health care data and how effectively we can make them accessible and actionable for key stakeholders.

The Medicare Shared Savings Program (MSSP) has seen its growth slow, but CMS has an opportunity to act on proposals that would address benchmarking and more fairly allocate savings to accountable care organizations in the program.

Ahead of Medicare open enrollment, which starts October 15, CMS released its annual report of which Medicare Advantage (MA) and Part D drug plans achieved 5-star ratings.

Psychographics is a way of categorizing someone based on their everyday behaviors using data that are collected every time they go to the store or post on social media, said Robert Groves, MD, executive vice president and chief medical officer at Banner | Aetna. In health care, psychographics can be used to positively influence someone to their benefit.

Migraines plague some 35 million Americans, the majority of them women in their 30s and 40s, and disabling pain and symptoms are linked to lost productivity at work, school, and home. On this episode of Managed Care Cast, we bring you an excerpt of an interview with a headache specialist about the extra challenges for patients and providers during the pandemic.

The Oncology Care Model (OCM) was a great program that led to practice transformation and improved patient care, but there needs to be a way to address the high cost of cancer therapies, said Marcus Neubauer, MD, chief medical officer of the US Oncology Network.

Anemia, fevers, dehydration, and other side effects from cancer treatment are all candidates for targeting with predictive analytics in an effort to care for patients are home instead of the hospital, said Elizabeth Kwo, MD, MBA, MPH, the deputy chief clinical officer at Anthem BCBS, and a speaker at the 10th anniversary of Patient-Centered Oncology Care® conference.

For patients with heart failure and cardiovascular disease, high intensity interval training has a greater positive effect on cardiorespiratory fitness than moderate intensity continuous training.

With the Oncology Care Model (OCM) slated to end in 2022, the successor model is still not in place. According to panelists, there is likely going to be a gap after OCM ends and the new model begins, but more importantly, practices should prepare for the new model to be mandatory.

The Oncology Care Model (OCM) is scheduled to end in just a few months, but with no new model in place to succeed it and practices still struggling during the pandemic, OCM should continue in its current form, said Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care Associations, current president of the Community Oncology Alliance, and co-chair of Patient-Centered Oncology Care®.

In the opening sessions at the Patient-Centered Oncology Care® conference, held September 23-24 both virtually and in Nashville, Tennessee, speakers focused on addressing disparities by getting involved and engaged with the community.

Having the option of receiving care in their community instead of a large hospital located hours away is not only a benefit for many patients, but research is showing community oncology practices are a low-cost, high-quality provider of care, explained Jeff Patton, MD, executive chairman of Tennessee Oncology and CEO of OneOncology.

On the opening day of Patient-Centered Oncology Care, Robert Groves, MD, of Banner | Aetna, discussed the use of psychographics to predict health behavior in local populations.