Interviews

It’s crucial for accountable care organizations to not only understand what value-based purchasing is, but for everyone to be on the same page as far as the expectations involved and what exactly it takes to get there, said Brian Marcotte, president and CEO of The National Business Group on Health.

The new Medicare Part B proposal from CMS has been controversial, and Steve Miller, MD, senior vice president and chief medical officer of Express Scripts, understands both sides of the argument. While he appreciates CMS' dedication to innovation, the demonstration may drive up payer costs.

Karen Ignagni discusses taking over EmblemHealth and implementing a turnaround after the company experienced net losses of more than $485 million in 2014, as well as the healthcare industry's transition to value-based payment.

Julia Adler-Milstein, PhD, assistant professor at the School of Information and the School of Public Health at the University of Michigan, describes the challenges of data gathering, and ensuring not only that the data is accurate and complete, but that the patient can use that data and ultimately lead a healthier lifestyle with that knowledge.

The process for approving biosimilars has been moving slowly, but Aimee Tharaldson, PharmD, senior clinical consultant of emerging therapies at Express Scripts, foresees them as having the potential to lower costs for the industry and hopes the approval process will pick up speed.

With only 3 medications FDA-approved to treat opioid addiction, patient access to these treatment options can be difficult, and each medication presents its own challenges, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine.

As the name and meaning of specialty medications have grown over time, so too has the importance of these pharmaceuticals, said Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review.

Since the implementation of ACA, Florida Blue’s enrollment plans have changed in that plan has expanded its outreach platforms and had to educate a larger audience of consumers, explained Anne Jessup, senior director of digital channels at Florida Blue.

The new accountable care organization (ACO) benchmarking rule changes it so ACOs aren't just competing against themselves and transitions so ACOs have to be better than others in their region, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.

In order to slow the rising costs of prescription drugs there has to be a greater emphasis on value-based payments, on transparency, and on the consumer, perhaps even with the government’s help, said John Bennett, MD, FACC, FACP, president and CEO of CDPHP.

Lonny Reisman, MD, CEO of HealthReveal, expects big data to help achieve the triple aim goals by combining disparate sources of rich and varied information.

High-deductible health plans have a role to play, but it's important that they aren't used in such a way as to create a disincentive of the use of a consumer's benefits, said Niteesh Choudhry, MD, PhD, associate professor of medicine at Harvard Medical School.

Having psychosocial support for patients with cancer, and for their family members, is critical, because patients often feel that their emotional needs are overlooked in busy clinics, said Sophia K. Smith, PhD, MSW, associate professor at the Duke School of Nursing.

High costs associated with specialty pharmacy will necessitate the evolution of a new specialized model to help ensure that patients are receiving the financial assistance they need and adhering to their treatment, according to Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

The bar is set very high in terms of the biosimilar requirement definition, and physicians who are hesitant about substituting biosimilars for treatment should not be worried about the perceived differences, according to Pamela S. Becker, MD, PhD, professor of medicine in the Division of Hematology at the University of Washington School of Medicine.

Defining value of a treatment can be complicated, but at the center of it is the need to include both long-term and short-term effects, said Steven Pearson, MD, MSc, FRCP, founder and president of the Institute for Clinical and Economic Review.

In order for providers to achieve balance between patients who want more direction and patients who want more autonomy, the healthcare industry must first find some measure of patient engagement, said Julia Adler-Milstein, PhD, assistant professor at the School of Information and the School of Public Health at the University of Michigan.

Telemedicine works well with diabetes because it is a condition that works with a lot of numbers and data, and physicians can look at that data remotely rather than requiring a face-to-face visit, explained David Brumley, MD, MBA, senior medical director at Tufts Health Plan.

Accountable care organizations have to work more on engaging physicians in meaningful leadership roles and should focus on learning about patient goals, said James Whitfill, MD, chief medical officer of Scottsdale Health Partners.

In order to provide care to people with behavioral health issues early, in the primary care setting, Carolinas HealthCare System set up a virtual behavioral health provider team that can provide care to the 200 primary care offices and roughly 800,000 people in need that are part of the system, explained John Santopietro, chief clinical officer of behavioral health at Carolinas HealthCare System.

With the Affordable Care Act expanding access to healthcare coverage, health plans have to handle consumers who are very different: some are very new to healthcare, some are more knowledgeable, some are healthy and never use care, and some are chronically ill, explained Robin Wright King, MBA, of Blue Cross Blue Shield of Massachusetts.

There is much excitement over the new checkpoint inhibitors, which have shown benefit across a variety of tumors. Right now, researchers are trying to define the subgroup of patients with breast cancer who might be most suited to checkpoint inhibitors, explained Lee Schwartzberg, MD, FACP, chief of Division of Hematology Oncology and professor of medicine at the University of Tennessee Health Science Center.

Measurement is essential to improving care and having the equivalent measurements across the field will allow clinicians and providers to be held accountable for the care they provide, said Chip Kahn, president and CEO of the Federation of American Hospitals.

While at the National Comprehensive Cancer Network’s 21st Annual Meeting, John A. Thompson, MD, co-director of the Melanoma Clinic at the Seattle Cancer Care Alliance, discussed screening and diagnosis of melanoma, immunotherapy, and biomarkers.

In order for accountable care organizations to overcome short-term thinking they must be careful with their fee-for-service codes and ensure that people are using the system responsibly, Farzad Mostashari, MD, chief executive officer of Aledade, said at the National Association of ACOs Spring 2016 Conference.

The Medicare Part B demonstration has been controversial since its announcement, but Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review, considers it a wise move on the part of CMS because it provides an opportunity to learn about different payment structures.

Patients and families can still have a limited understanding of palliative care, which may mean they have an open mind toward the suggestion, said Toby C. Campbell, MD, MSCI, associate professor of medicine, hematology-oncology at the University of Wisconsin School of Medicine and Public Health.

In addition to the federal government, state regulators and state insurance commissioners should play a role when considering regulation of recently proposed health insurance mergers, said Sarah Lueck, senior policy analyst from the Center on Budget and Policy Priorities.

In order for consumers to receive the best care for the best cost, it is important for them to be educated about what healthcare services they purchase, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

When pricing new drugs, it’s difficult to understand how their performance will play out in the long term, and for that reason, Institute for Clinical and Economic Review (ICER) has created models that predict future costs and benefits, said Steven Pearson, MD, MSc, FRCP, founder and president of ICER.