Health Care Cost

Gene therapy is a novel approach to hemophilia A treatment that carries a substantial cost up front but may lead to cost savings compared with current prophylaxis agents in the long run.

Daniel E. Weiner, MD, MS, board certified nephrologist and lead navigator at Tufts Clinical and Translational Science Institute, spoke on the limitations and future potential of value-based payment systems for chronic kidney disease (CKD), including the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Kidney Care Choices (KCC) Models.

It has been 3 years since new kidney care payment models were announced by HHS, and at a session at Kidney Week 2022, the associate division director of nephrology at the University of Alabama at Birmingham described his organization’s participation in Kidney Care First, one of the value-based care models announced in 2019.

A poster presented at the Academy of Managed Care Pharmacy Nexus 2022 showed that patients with recurrent Clostridioides difficile infection (rCDI), who had Medicare Advantage Part D coverage or were enrolled in a commercial health plan were associated with significantly greater health care resource utilization, including emergency department and inpatient visits, compared with those without rCDI.

A poster presented at Academy of Managed Care Pharmacy Nexus 2022 shows that patients with intermediate Parkinson disease place a significant resource burden on the US health care system in regard to treatment, emergency department visits, and admissions to rehabilitation centers.

Jim H. Rhodes, deputy county administrator, Camden County, New Jersey, spoke on how his organization’s membership with the Greater Philadelphia Business Coalition on Health (GPBCH) has aided their value-based initiatives in improving health equity in the region.

Emergency department (ED) readmission was more common than dermatology follow-up among patients with hidradenitis suppurativa (HS) within 30 and 180 days of initially presenting to the ED, with patients with Medicaid coverage and those who had an opioid prescribed were more likely to return.

Brian Corvino, MBA, managing director, Life Sciences and Health Care Practice, Deloitte Consulting, LLP, offered an overview of how the surge of innovation in oncology—and resulting drug approvals—dominate the biopharmaceutical sector. He spoke at the Community Oncology Alliance's Payer Exchange Summit.

Neil Goldfarb, president and CEO of Greater Philadelphia Business Coalition on Health (GPBCH), spoke on the biggest challenges facing GPBCH in advancing health care value, how national organizations are helping drive innovation, and the future role of business coalitions in the health care system.

The limited data on heart failure (HF)-related mortality among young adults, those aged 15 to 44 years, prompted this analysis of data from 1999 to 2019 that considered HF as a contributing or underlying cause of death.

Panelists who have reviewed the Enhancing Oncology Model (EOM) say it puts additional requirements on practices with reduced monthly payments, and its risk modeling could put a small practice out of business.

Black and Latino Americans saw surges in health care insurance enrollment through the Affordable Care Act (ACA) between 2020 and 2022; Medicaid enrollment and spending is expected to slow in 2023; the Biden administration is preparing a national hepatitis C treatment plan.

Despite known racial disparities in access to advanced heart failure (HF) treatments, the reasons for this continue to require further exploration. In this new study, investigators searched for associations between ventricular assist device use and heart transplant and race (Black or White).

CDC advisory group votes to add COVID-19 vaccines to the pediatric immunization schedule; a new report says workplaces can be hazardous to the mental and physical health of Americans; drug makers are lobbying to ease the impact of the Inflation Reduction Act.

The goal of this new study was to gain more information on the disease burden, including costs, of patients living with chronic rhinosinusitis with nasal polyps (CRSwNP).

Black and Hispanic patients living with chronic inflammatory skin disease (CISD) have more barriers to care compared with White patients with CISD, according to a recent study.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members with support for rare, complex conditions.

The concluding keynote address at the Academy of Managed Care Pharmacy Nexus 2022 meeting discussed new and emerging oncology drugs in the pipeline and their potential impact on the treatment landscape as it pertains to managed care providers.

President Joe Biden is directing HHS, through an executive order, to use the Innovation Center to lower drug prices; the US extended the COVID-19 public health emergency for another 90 days; the CDC reported that 75% of teenagers experienced adverse childhood experiences in 2021, which worsened their mental health.

There have been many silver linings of the pandemic, including improvements in financial, operational, and clinical advancement efficiencies, as well as addressing the total cost of care in population health management, said Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute.

Integrated primary care services may offer better outcomes in patients living with severe chronic obstructive pulmonary disease (COPD) without increasing costs.

Two posters presented at AMCP Nexus 2022 addressed the cost-effectiveness of guideline-recommended integrase strand transfer inhibitor–based triple therapy in people living with HIV, as well as the efficacy of adjuvant lenacapavir in treatment-naïve patients.

New and emerging medications in the specialty drug pipeline were discussed during a keynote address at AMCP Nexus 2022 by Aimee Tharaldson, PhD, senior clinical pharmacist of emerging therapeutics at Express Scripts, with biosimilars, orphan drugs, and cell and gene therapies emerging as key trends to watch.

On this episode of Managed Care Cast, we speak with Matthew D. Eisenberg, PhD, lead author of a study published in the October issue of The American Journal of Managed Care® that investigated the use of high-deductible health plans and their impact on substance use disorder care and spending.