Interviews

Although patients are being asked to pay more when it comes to their healthcare, the concept of having more "skin in the game" is misguided when it comes to healthcare, according to Elise Gould, PhD, senior economist and director of health policy research at the Economic Policy Institute.

The healthcare system in the US makes it nearly impossible for patients and physicians to form a real relationship, and patients are rarely asked about what's going on in their lives, which could inform treatment, said Marc Boutin, JD, chief executive officer of the National Health Council.

David Blumenthal, MD, MPP, president of The Commonwealth Fund, believes that managed care has lost some of its focus and he would like to see more attention paid to holistic management of care for the frailest, sickest patients.

Palliative care should enter into the discussion with patients with cancer as early as possible as it can manage symptoms from therapy or it can provide comfort to patients who cannot afford or choose to forgo therapy, said Amy Davidoff, PhD, MS. Plus, she discusses the impact biosimilars may have on therapy costs.

Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.

The earlier you intervene with patients with mental health issues, the better the outcome for both the individual and the health system. Early intervention prevents pain and suffering and actually saves costs in the long run, said John Santopietro, MD, chief clinical officer of behavioral health at Carolinas HealthCare System.

One of the biggest challenges with measuring primary medication nonadherence is coming up with a definition for it in the first place.

Julie Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology and keynote speaker at Patient-Centered Oncology Care 2015, explains the importance of the meeting and how patients benefit when a diverse set of stakeholders come together in one room.

Lonny Reisman, MD, chief executive officer of HealthReveal, has a long history with The American Journal of Managed Care and its co-editors-in-chief A. Mark Fendrick, MD, and Michael E. Chernew, PhD, and said he is grateful for the work the journal has done over the years.

With pay-for-performance evolving from the "check-the-box" model, providers need to learn to work within teams that can understand these new programs, explained Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

The real-world evidence being published in The American Journal of Managed Care has made the journal the most important journal for payers to read, according to Dana Goldman, PhD.

Elise Berliner, PhD, director of the Technology Assessment Program in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality, explains how the agency is using horizon scanning to peer into the future of treatments.

The next 20 years will bring greater use of big data and health information technology in managed care, but the challenge is using that technology to place patients in charge of their own healthcare, said Rajesh Balkrishnan, PhD, associate director for research and education at the University of Michigan Center for Global Health.

Although primary care is important, it may not be the center of the care model for patients with chronic diseases, like type 2 diabetes, and these providers are usually just a part of a larger ecosystem of providers, said Andrew Pumerantz, DO, FACP.

As the National Comprehensive Cancer Network (NCCN) celebrates 20 years, Clifford Goodman, PhD, takes a look at how NCCN will evolve after another 20 years, including constant streaming of real-time data and more patient involvement.

As the United States looks to reform its healthcare system to provide better value at lower costs, the real challenge is innovating at scale across the country, said Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Over the years, the research published by The American Journal of Managed Care has been key in understanding the link between value and outcomes and what is paid for healthcare services, said Charles N. Kahn III, MPH, president and CEO of the Federation of American Hospitals.

Although cost-effectiveness analysis has not been a formal part of cardiology clinical guidelines until recently, it has "always been the elephant in the room," said Mark Hlatky, MD, professor of health research and policy and professor of cardiovascular medicine at Stanford University.

As CMS moves to value-based payments, having good measures of value that payers and providers trust will be critical, explained Stuart Guterman, senior scholar in residence AcademyHealth.

Given how much technology will evolve over the next 20 years, predicting the future of healthcare is almost impossible, but Margaret O'Kane, MHA, president of the National Committee for Quality Assurance, expects big things from telemedicine and predicts new investigations in motivating patients to take control of their own wellness.

Current care areas with gaps in measurement and the next generation of performance measures, according to Rebecca Snead, RPh, executive vice president and chief executive officer of the National Alliance of State Pharmacy Associations and a member of the board of directors for the Pharmacy Quality Alliance.

The ability to charge increasingly higher prices for drugs that already have competition on the market is stifling innovation and wasting resources and human subjects, according to Peter Bach, MD, MAPP, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes.

Healthcare practitioners are well aware that the rising cost of medical advances may affect their ability to deliver great care to all their patients, but there are ways they can address the issue, said Joseph Alvarnas, MD, the editor-in-chief of Evidence-Based Oncology.

Creating a statement that mental health and physical health have parity is important for achieving outcomes in patients with chronic illnesses, said Trishan Panch, MBBS, MPH, chief medical officer at Wellframe.

Jan Berger, MD, MJ, wishes The American Journal of Managed Care a happy 20th anniversary and looks forward to another 20 years, plus she looks forward to the 20th anniversary of sister publication The American Journal of Pharmacy Benefits, of which Dr Berger is the editor-in-chief.

Kim Thiboldeaux, chief executive officer of the Cancer Support Community, discusses the importance of providing strong community support, the misconceptions of clinical trials, and creating a tailored care plan.

There are a couple of health information technology challenges facing new accountable care organizations that are bringing together different entities with disparate systems that need to learn to work together, explained Scott Berkowitz, MD, MBA.

At Community Care of North Carolina, there is not only a focus on global performance metrics, but also the programs and metrics that will contribute to improving those global outcomes metrics, explained Troy Trygstad, PharmD, MBA, PhD, vice president of pharmacy programs at Community Care of North Carolina.

The first year to 18 months of an accountable care organization (ACO) is the most challenging as data begins to trickle in of everywhere a patient went to get care, and healthcare providers typically aren't taught how to utilize that information, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

For individuals who have not made the sort of risk-averse decisions in their lives that lead to better jobs and wealth accumulation, making treatment decisions after a cancer diagnosis can be very difficult, said Amy Davidoff, PhD, MS, senior research scientist in public health at the Yale School of Public Health