Interviews

While there is no limit on the number of patients a physician can prescribe buprenorphine when sought for pain, physicians face governmental limitations on prescribing this medication to patients who need it as treatment for opioid addiction, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine. These restrictions have in turn created several patient access roadblocks to the needed medication.

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, believes that while the tone of this year’s presidential election race has been interesting, the discussion among the candidates regarding issues of healthcare and coverage have generally been the same as elections in years past.

Many stakeholders in healthcare have concerns about the same issues just from different vantage points, they just need to be brought together in order to enact any change, explained Linda Schwimmer, JD, president and CEO at the New Jersey Health Care Quality Institute.

Patient adherence is about combining the appropriate tests, lifestyle changes and medications to produce the most optimal health outcomes, said Scott Breidbart, MD, MBA, chief clinical officer of EmblemHealth. However, he added that deciding when to pay physicians and patients for adherence and where payment may not be successful is a difficult model to tackle.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, explained that the 2 gaps that exist in quality measurement currently include data infrastructure and patient engagement.

Lidia Fonseca, senior vice president and chief information officer of Quest Diagnostics, explains where the future of data analytics is going in healthcare as the industry moves to value-based care.

Technology has come to play an important role in the way health plans are interacting with consumers. According to Jay Sheehy, senior vice president of product innovation at EmblemHealth, technology not only gives health plans customized means of communicating with consumers, but it also allows them to better analyze data to tailor messages to each individual.

Patient-reported outcomes are important and necessary measures that should be used more, as they give the patient a voice in terms of the quality of care they receive, said Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum.

The American Enterprise Institute released a report that detailed several proposals of change for the ACA that could possibly be implemented with the next president. Joe Antos, PhD, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, said that though these changes would depend on the party in office, implementing them wouldn’t necessarily be easy.

The upcoming election is going to play a large role in the future of Obamacare, which Patricia Salber, MD, MBA, of The Doctor Weighs In, believes will show an increased number of states expanding Medicaid. She added that the ticket will be important in determining the types of legislatures at the state level in the coming years, which in the end determines whether Medicaid will expand in the holdout states.

Recently, there has been more evidence highlighting the importance of social needs interventions, as these measures get to the root of a patient’s specific health issue and can ultimately impact the sustainability of the healthcare system as well as the patient’s quality of life, said Rocco Perla, president of Health Leads.

Communication and education about the available health coverage options was important in keeping consumers informed about enrollment, which Jennifer Sullivan, director of the Best Practices Institute at Enroll America, said was key in engaging consumers.

Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation, discussed innovation happening in healthcare and the growing discussion around social determinants of health and addressing the upstream drivers of health.

Healthcare providers sometimes fail to consider the other aspects of a patient's life that could be affecting physical health and wellness, said Karin VanZant, executive director of Life Services at CareSource.

Stephen Rosenthal, chief operating officer of The Care Management Company at Montefiore Medical Center, said that population health strategies are the future of the health system, where networks would be responsible for the total costs of care for the population they service.

New health technologies will not automatically address disparities-it all depends on how those tools are used, explained Julia Adler-Milstein, PhD, assistant professor at the School of Information and the School of Public Health at the University of Michigan.

The 7 sets of core quality measures from America's Health Insurance Plans (AHIP) and CMS derived from looking at areas that were either high prevalence or high cost, said Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at AHIP.

The value discussion in healthcare is becoming more relevant as the healthcare system increases its focus on better outcomes, said Stephen Grubbs, MD, vice president for clinical affairs at the American Society for Clinical Oncology.

Marcia Wilson, PhD, MBA, senior vice president of quality measurement at The National Quality Forum, explained that one’s opinion of quality measures comes from the type of work they are in — while a primary care physician may think there are too many, a health plan could believe there’s not enough. The challenge then, she added, is filling these gaps by creating and testing new, outcome-driven measures.

Specialty pharmacy may be one of the most rapidly rising costs in all of healthcare, but these costs are shouldered by a small percentage of patients. As such, it is essential that new innovative payment models be developed for these new products, said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

Helen Burstin, MD, MPH, FACP, chief scientific officer of The National Quality Forum, said that quality measurement is at the core of transitioning to value-based payment, and that the initiative can’t truly move forward without putting the work in to identify and define what that value is.

Sustainability in the Affordable Care Act marketplaces will occur when the health plans and the providers come together to establish both cost and quality goals and work together to achieve them, explained Karen Ignagni, president and CEO of EmblemHealth.

Although the term "accountable care organization" (ACO) may not be here to stay, value-based organizations are here to stay based on the direction CMS is headed, said Jeb Dunkelberger, vice president of accountable care services at McKesson and clinical & commercial operations at ACO Partner.

There are desirable and undesirable effects of high-deductible health plans, and the use of value-based insurance design may mitigate adverse effects of these plans, explained Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Orphan drugs are a very lucrative business, and Aimee Tharaldson, PharmD, senior clinical consultant of emerging therapies at Express Scripts, expects to see more orphan drugs reach market as manufacturers focus their development efforts in these areas.

The United States is closer than it has ever been to considering a single-payer health system. Patricia Salber, MD, MBA, of The Doctor Weighs In, discusses how a single-payer system economically makes sense.

Increased risk arrangements have placed more accountability on the provider’s part when it comes to a patient’s care, said Albert Tzeel, MD, MHSA, FAAPL, regional medical director of senior products at Humana.

Although cancer care costs are rising, it is proportional to the total utilization of healthcare resources and spending growth is happening more in areas that have seen innovation, explained Debra Patt, MD, MPH, MBA, director of public policy at Texas Oncology.

With the development of Kaiser Permanente’s new medical school comes an emerging philosophy to more directly align medical education with the industry’s current transition to more integrated, holistic approaches to care, said Bernard J. Tyson, chairman and CEO of Kaiser Permanente.

Incorporating big data is essential as it can help explain failures in medical practice, accumulate patient information, and perform a variety of other useful functions, explained Lonny Reisman, MD, CEO of HealthReveal.