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Individualizing Therapy in Patient Subpopulations Without Compromising Contracts


The panel closes the program with giving their final thoughts on individualizing therapies for plaque psoriasis and metabolic syndrome in specific patient subpopulations.

Ryan Haumschild, PharmD, MS, MBA: Well, we are closing, this has been a really great discussion. I can’t thank each of you enough for all the great value that you’ve brought, from your knowledge to your population health management, to the payer management of this space. Before we close, I just want to say, again, thanks to all of you for this rich and informative discussion. I’d like to get 1- to 2-minute final thoughts from each of you, as we part ways, on this very topic. One of the ways I think about it is, when we think about patient populations, in plaque psoriasis and other areas, what is the value proposition we can find as a payer to reduce total cost of care, but also better care for a unique patient population? Sometimes, that’s looking past acquisition costs, sometimes it’s looking at the whole cost of care. And looking at these reinitiations, and these costs that exist that may need more attention to improve the care of our members, and also on the healthcare side, achieving those best practice outcomes. Hopefully, care pathways and artificial intelligence [AI] are the future in how we start to treat these patients more intentionally, thinking of unique subpopulations instead of just branding everyone as a whole. With that being said, I’ll go around the block to all 3 of you. We’ll start with Dr Lebwohl, then we’ll go to Dr Shah, and then Dr Groves, you can finish this out.

Mark Lebwohl, MD: My point of view here is that we have the ability today that we did not have in the past, to take almost anyone and completely clear their skin, protect their joints, and make their lives as close to normal as possible. This is an inherited condition. We’re not curing you, but we are making you as close to normal as possible. The benefit for patients is clear, the benefit for employers is that they will have an employee who lives longer and is more productive. Thus, that would be my main closing thought.

Bhavesh Shah, PharmD: I like the fact that where we are currently, even the FDA is pushing toward more real-world evidence generation that can help, because we know that it takes so long to put together a study and design it properly. And you have a lot of evidence at your fingertips. Using that evidence and using guidance from an agency like the FDA to capture the evidence we need to get that perspective to treat that patient and lower the total cost of care, that would save us a lot of time and effort [rather than] putting together a phase 3 randomized controlled trial that’s just looking at metabolic syndrome in this patient population. I really think that using tools like real-world evidence to show how we should optimize therapies, that should be our future goal.

Robert Groves, MD: What I would say is I always learn something in these panels. It just is so amazing to be connected to bright people who have areas of expertise that I simply don’t have. Thank you for that. I’m optimistic about the future. The reason I’m optimistic is because I think we’re learning how to engage practice-based evidence, and we’re learning how to more and more personalize our approach to individual patients. We’re learning how to leverage AI to improve operations. Ideally, the way things should work is that the physician and the patient should have the knowledge management at their fingertips. Thus, from the get-go, they choose the best option available based on all of those data available at the time. And the insurance company is out of the way unless there’s a problem. That’s not the way it works today, and it frustrates all of us. A big step in getting there is also getting rid of the perverse incentives that pit us against each other instead of aligning us in service of the patient. Ultimately, that’s where we want to be. And efforts like this, learning how to use the practice-based evidence, learning in detail about the relationship between metabolic syndrome and psoriasis, this is a great example of the kinds of discussions that we ought to be having to move us forward into the future.

Ryan Haumschild, PharmD, MS, MBA: Thank you again. And to our viewing audience, we hope you found this AJMC® Peer Exchange discussion to be useful and informative.

This transcript has been edited for clarity.

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