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How "Clinical Efficacy" Can Rein in Healthcare Costs


The latest installment in the 20th anniversary commentary series in The American Journal of Managed Care explores the concept of "clinical efficacy." This healthcare delivery model asks stakeholders to make use of data and value-based contracts that reward early intervention in high-risk patients.


PLAINSBORO, N.J.—How can healthcare meet the challenge of rewarding its participants—physicians, drug makers, diagnostic services, and others—to hold down costs?

In a commentary for The American Journal of Managed Care, Lonny Reisman, MD, chief executive officer of HealthReveal, presents the concept of “clinical efficacy,” which would bind parties together in agreements to intervene at the earliest signs of trouble—and be rewarded for doing so.

The full article, “Clinical Efficacy: A Cost-Containment Weapon for the 21st Century,” can be found here.

“Clinical efficacy” would rely on analysis of various data sources including digital monitors, that identify those patients most at risk of future costly events—like strokes or heart attacks—and treat them before problems arise. As Reisman explains, clinical efficacy cannot work without buy-in from those stakeholders who should be rewarded based on their value in preventing avoidable complications of disease.

“To embark on a journey centered on medical excellence, delivery systems and suppliers of diagnostic services, devices, and pharmaceuticals will need to participate in health ecosystems with value/risk-based contracts that reward superior clinical and financial results,” Reisman writes.

Creating incentives to preempt illness and medical events is the only way to keep costs from escalating at their current rate, he writes.

Reisman’s commentary is part of a year-long series appearing in The American Journal of Managed Care to mark the publication’s 20th anniversary. To access the series and other material related to the anniversary, please visit the special anniversary page.

About the Journals and AJMC.com

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policy makers, and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT: Nicole Beagin (609) 716-7777 x 131



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