Interviews

The healthcare systems in Germany and the United Kingdom are examples of systems that are able to manage costs while improving access to medications; however, it is unlikely that the US will follow these models, explained Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health.

Employers understand what accountable care organizations are, but they need a better understanding of how they deliver value better than the market, explained Brian Marcotte, president and CEO of the National Business Group on Health

The US biosimilar market is developing, but its sustainability in the market is still unknown, according to Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team.

UnitedHealth is currently involved in 2 types of value-based contracts with its provider partners, but it has seen more success with one compared with the other, explained Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare.

Peer-to-peer support programs motivate and encourage patients to make better healthcare choices but they require certain regulations and processes to function properly and effectively, says Andrea Baer, director of Patient Advocacy for Mended Hearts.

Public interest and what is in the best public interest can vary from court to court, and in the case of Amgen v Sanofi, it has yet to be determined if public interest will be considered, explained Ha Kung Wong, JD, partner at Fitzpatrick, Cella, Harper and Scinto.

The public health community, the provider community, and the general public need to help the pharmaceutical industry increase access to services and put downward pressure on costs, said Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health.

Biosimilars products can affect the development of new reimbursement models and formulary placement strategies as more people become educated on biosimilars, explained Amanda Forys, MBA, director of Xcenda’s Reimbursement Policy Insights consulting team.

Building strong teams and creating a support system is important in implementing innovation in primary care, according to Alicia Berkemeyer, vice president of Enterprise Primary Care and Pharmacy Programs at Arkansas Blue Cross and Blue Shield.

Zirui Song, MD, PhD, resident at Massachusetts General Hospital, discussed his research interests, which center on strategies to control healthcare spending while improving the quality of care. He also expressed the importance of examining health equity within the United States healthcare system.

There are non-financial barriers that contribute to why a patient does not adhere to their medications, according to Andrea Baer, director of Patient Advocacy for Mended Hearts.

Europe has found ways to make value-based care work, but the US market is very different, which means there are different factors in the United States that can work to encourage high-value care, according to Jennifer Graff, PharmD, vice president of comparative effectiveness research at the National Pharmaceutical Council.

Payers acknowledge obesity as a public health issue and are working to establish offerings that align with USPSTF recommendations in order to treat and prevent obesity, says Jenny Bogard, MPH, director of healthcare strategies at the Alliance for a Healthier Generation.

Public and private payment reforms such as accountable care organization contracts have shown some initial evidence of changes in physician behavior, but their full promise remains to be seen, according to Zirui Song, MD, PhD, resident at Massachusetts General Hospital.

Incentives must be aligned between payers and providers to transition to value-based care and physicians must have the best access to information to make the right decisions in these value-based arrangements, explains L. Patrick James, MD, chief clinical officer for health plans and policy, medical affairs, for Quest Diagnostics

The Alliance for a Healthier Generation believes in giving the youth the chance to live a healthier life and will continue to create healthier options at schools despite the current administration’s restriction reductions, claims Jenny Bogard, MPH, director of healthcare strategies at the Alliance for a Healthier Generation.

Being a nurse before being the director of the National Library of Medicine allowed Patricia Flatley Brennan, RN, PhD, a greater appreciation and understanding of the need for information at the point of care and a need to provide patients with information to practice self-care and self-management.

Payers recognize the importance of obesity care and prevention, but can find it difficult to justify and investment in a program that might not show benefits for years to come, explained Jenny Bogard, MPH, director of healthcare strategies at the Alliance for a Healthier Generation.

The forces pushing the country toward value-based care will continue regardless of who is in control in Washington, DC, said L. Patrick James, MD, chief clinical officer for health plans and policy, medical affairs, for Quest Diagnostics.

Emerging technology in the patient-clinician relationship and more rapidly developed data-driven knowledge will accelerate care, according to Patricia Flatley Brennan, RN, PhD, director of the National Library of Medicine.

Based on past efforts like the Affordable Care Act and projected future trends, some level of government intervention will be needed to help the healthcare market offer patients access and choice at an affordable price, explained Daniel J. Klein, president and CEO of the Patient Access Network Foundation.

As Hennepin Health expands its focus from the Medicaid expansion population of single adults to families and children, it will need to shift the way it views return on investment since there can be large upfront costs with returns happening years later with this new population, explained Ross Owen, health strategy director of Hennepin County.

Preventing the progression of diabetes can help patients maintain a healthy quality of life while saving significant costs, said Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital.

The provision in the Affordable Care Act to remove cost sharing for preventive care visits created a shift in how Medicare pays with a greater emphasis on prevention and managing chronic diseases, and less on treatment of acute illness, said Mariétou Ouayogodé, PhD, post-doctoral fellow at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.

The National Library of Medicine (NLM) isn't a library in the traditional sense of a building with book and a librarian to help research, explained Patricia Flatley Brennan, RN, PhD, director of the NLM. NLM is a digitized envrinoment that connects people and researchers worldwide.

Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center, discussed several ways primary care offices can transform their practices to provide optimal diabetes care. These include quality improvement, data analysis, and benchmarking initiatives to make the office more diabetes-friendly.

Fee-for-service payment models have not been successful in the field of palliative care, where small practices seem to work better under flexible programs like per member per month, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

According to Daniel J. Klein, president and CEO of the Patient Access Network Foundation, patients now have an easier time accessing the high-cost treatments they need, thanks to certain policies and programs. Klein also anticipates that a recently-passed law will bring down the prices of some prescription drugs.

There are changes and clarifications to definitions that are needed in the 340B program, but that won't likely happen anytime soon in this Congress. In the meantime, various stakeholders should take the time to educate one another on what the program means to them, said Neil Minkoff, MD, chief medical officer of EmpiraMed.

The Samfund is primarily known for its grant funding programs that help young adults with financial struggles after having cancer, but founder and CEO Samantha Watson discussed how the organization has expanded into providing financial literacy education and other tools to support the community of cancer patients.