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The title "Reshaping the Relationship Between Physicians and PBMs" suggested that the Sunday session at the 2017 American College of Rheumatology’s Annual Meeting in San Diego, California, would focus on reconciling the goals of providers and pharmacy benefit managers (PBMs), but physicians’ challenges in dealing with PBMs quickly became the primary focus of the panel discussion.

Among the most anticipated sessions at the 2017 meeting of the American College of Rheumatology in San Diego, California was “The Great Debate: Biosimilars…to Switch, or Not to Switch? That Is the Question.”

The healthcare industry is getting better at creating value-based drug pricing arrangements, and even if they never dominate the market, there will always be a place for these contracts, said Ira Klein, MD, MBA, FACP, senior director of healthcare quality strategy for the Strategic Customer Group at Janssen Pharmaceuticals.

The biggest challenges in promoting cardiovascular prevention strategies is motivating people to change a lifetime of poor habits into healthier habits, explained Christi Deaton, PhD, RN, FAHA, FESC, of the University of Cambridge.

During the final panel at the fall meeting of the ACO & Emerging Healthcare Delivery Coalition® in Nashville, Tennessee, panelists discussed the progress specialties have made in moving to value-based payment models, as well as the challenges facing the industry as a whole. The panel consisted of 3 individuals who provided perspectives from specific specialties, and 1 with an overall policy perspective.

Improving treatment for addiction means first recognizing that addiction is a chronic disease and also understanding that relapse is part of the disease process, explained Frank James, MD, JD, of American Society of Addiction Medicine.

There have been tremendous improvements in healthcare quality and performance measurements, but one area where more needs to be done is incorporating social risk factors into these measurements, said Shantanu Agrawal, MD, CEO and president of National Quality Forum.

At the fall ACO & Emerging Healthcare Delivery Coalition®, Clay Alspach, JD, principal at Leavitt Partners, discussed navigating the current political and payment reform landscape, making sense of the uncertainty, and preparing for the unexpected.

A back to back session and panel at the falls’ ACO & Emerging Healthcare Delivery Coalition focused on the importance of utilizing integrated healthcare to treat individuals with addiction and ensuring physicians are educated on understanding addiction.

A simple model can help health systems incorporate the social determinants of health into their clinical programs, according to presenters at the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

At a session during the National Association of Managed Care Physicians Fall Managed Care Forum 2017, speakers discussed how new approaches to encouraging medication adherence can help improve outcomes in patients with chronic diseases.

This fall's ACO & Emerging Healthcare Delivery Coalition

David V. Axene, FSA, FCA, CERA, MAAA, outlined how more accurately measuring and evaluating the performance of accountable care organizations (ACOs) can help both health plans and providers succeed in their risk sharing contracts during a session at the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

James R. Jett, MD, gave an overview of the advances in diagnosis and treatment of non–small cell lung cancer (NSCLC) during a session at the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

Industries including healthcare continue to adapt to the increasingly powerful voice of the consumer, according to Venkat Inumella, MBA, associate partner at McKinsey, who discussed this trend toward consumerism during the first keynote session of the National Association of Managed Care Physicians Fall Managed Care Forum 2017.

At the National Association of Managed Care Physicians Fall Managed Care Forum 2017, James J. Bleicher, MD, MHCM, regional president of SSM Health, discussed the foundational steps necessary for healthcare organizations looking to transform their business to focus on population health.

Tuple Health, a healthcare technology startup, interviewed some of the stakeholders participating in value-based care delivery and OCM, to gain their perspective of the state of cancer care and healthcare reform. The results were presented at the Community Oncology Alliance Payer Exchange Summit on Oncology Payment Reform.

Representatives from 3 payers who partnered with providers on the Oncology Care Model (OCM) took the stage at Community Oncology Alliance (COA)’s Payer Exchange Summit on Oncology Payment Reform to outline their experience with OCM and how it has differed from other care models.

Education is key to succeed in the Oncology Care Model, but presenting data in a simple format for clinicians to use is also critical, said Terrill Jordan, CEO, of Regional Cancer Care Associates.

Before physicians will be more willing to take on 2-sided risk, there needs to be clearer metrics that the physicians know will be achievable, said Sarah Cevallos, chief revenue cycle officer at Florida Cancer Specialists.

Implementing OCM has presented several challenges, such as manually submitting data, keeping up with status of therapy, and billing, said Jeff Patton, MD, CEO of Tennessee Oncology.

The implementation of the Oncology Care Model has brought profound culture changes to how oncologists take care of patients and how they operate practices, explained Lucio Gordan, MD, of Florida Cancer Specialists.

With the Oncology Care Model now in its second year, 3 representatives discussed learnings and how the program can change, as well as incentivizing physicians to accept 2-sided risk, the ability to engage additional payers, and the future of oncology bundle payments.

The digital transformation of the cardiology field in the coming years will have a huge impact on the delivery of healthcare, said John Rumsfeld, MD, PhD, chief innovation officer at the American College of Cardiology.

Participants from 2 oncology community practices—an oncologist–administrator combination—shared their experience with implementing the Oncology Care Model (OCM) with attendees at the Community Oncology Alliance’s Payer Exchange Summit on Oncology Payment Reform, held October 23-24, in Tysons Corner, Virginia.

Inviting patients to share their own health data can result in a better understanding of diseases and treatments beyond what can be learned from clinical data, according to a health data specialist who presented a session during the Academy of Managed Care Pharmacy 2017 Nexus meeting.

Outcomes-based risk sharing contracts will continue to become more common as health plans, providers, and drug manufacturers realize the benefits of these arrangements, according to speakers at a session of the Academy of Managed Care Pharmacy 2017 Nexus meeting.

At a session during the Academy of Managed Care Pharmacy 2017 Nexus meeting, a public policy expert argued that despite all of the news surrounding the Affordable Care Act (ACA), the US healthcare system may not see fundamental changes anytime soon.