Interviews

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

A survey of groups using and developing clinical pathways revealed 7 distinct themes that highlight how these pathways are created and used, and the challenges and barriers to creating new pathways, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

The concept of the value of new breakthrough therapies has become disconnected from the actual cost of them, but there are ways to better align the benefits and costs of treatments, according to Darius Lakdawalla, PhD, Quintiles Chair in Pharmaceutical Development and Regulatory Innovation at the University of Southern California Sol Price School of Public Policy.

When treatments get in the marketplace and are being recommended and used, there are actually still a lot of questions that can only be answered by researching real-world data, explained Joe V. Selby, MD, MPH, executive director of the Patient-Centered Outcomes Research Institute.

While it's exciting to see more and more physicians wanting to participate in clinical, they need a little background, support, and infrastructure to do so, said Robert Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

Sometimes patients are so concerned with being good patients that they simply agree to what the clinician has said without fully understanding, and it's important to ask questions and ensure their voices are heard, said Mary Lou Smith, MBA, co-founder of the Research Advocacy Network.

Only about one-fourth of all patients with behavioral health issues are diagnosed by a primary care provider and receive the appropriate treatment, said Paul Ciechanowski, MD, MPH.

Although hospital consolidation has not shown the benefits proponents had touted, it is inevitable that there will be consolidation in healthcare, because the environment is too challenging for smaller hospitals and many physician practices, explained Paul Ginsburg, PhD.

While the shift to cancer becoming more of a chronic disease does not have a huge change on the approach of the payer, there are some new challenges to address, said Jennifer Malin, MD, medical director for oncology at Anthem.

Patient engagement is in constant change and has evolved over the years into how care is delivered and how quality measures are developed, explained Marc Boutin, JD, chief executive officer

It's time for employers to consider more than just the medical benefits but the pharmacy benefits when it comes to specialty pharmaceuticals, said Cheryl Larson, BA, vice president of the Midwest Business Group on Health.

Restrictive prior authorization policies have made had a negative impact on schizophrenia patients, who tend to be an already-difficult population to treat, explained Dana Goldman, PhD.

The field of managed care has evolved greatly over the last 20 years, and The American Journal of Managed Care has kept those in the industry up to date with changes, said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation.

While health information technology can be a solution for primary medication nonadherence, it can also be burdensome, according to Lauren Harner, JD, senior manager of policy at PhRMA.

Funding from the 21st Century Cures Act to the FDA will help expedite the drug approval process without sacrificing the accountability and effectiveness of the FDA's standards, said Congressman Frank Pallone, Jr (D-NJ).

Patients with diabetes whose traditions and culture includes celebrations with food should not take a negative approach to lifestyle management and dietary restrictions, according to Andrew Pumerantz, DO, FACP, of the Western Diabetes Institute.

Patients with diabetes are entering a new era in which they can take charge of their own health and medical needs and come ready with questions and ideas to manage their disease, said Kerri Sparling, writer/editor of patient diabetes blog Six Until Me.

With various healthcare stakeholders having different wants and needs from the healthcare system, meetings that bring all parties together in one room are important, according to Suzanne F. Delbanco, executive director of Catalyst for Payment Reform, and keynote speaker at the spring live meeting of the ACO and Emerging Healthcare Delivery Coalition.

There are many cost-related pieces in the grand picture of care that are devastating to families and patients, including copayments, hospital visit bills, transportation fees, and drug prices.

As the human genome becomes more of a part of standard care, both the physician's responsibilities to his or her patients and the way care is delivered changes, explained Mark Kris, MD, William and Joy Ruane chair in thoracic oncology at Memorial Sloan Kettering Cancer Center.

When patients overestimate the benefits of intervention and underestimate the harms of treatments, they may not be receiving the right forms of care that they should be, said Austin Frakt, PhD, health economist and researcher.

Taking on the patient mindset, truly getting to know the patient and then incorporating the patient's caregiver team are ways that will better engage patients in their care, said Joseph C. Kvedar, MD, vice president of Connected Health at Partners HealthCare.

The largest and perhaps most noticeable barrier standing between a successful collaboration of primary care physicians and specialists is the lack of communication, said Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president of Joslin Diabetes Center.

Much of care coordination efforts for diabetes entail having the extra personnel to more closely manage patients and their behaviors, which in turn can improve medication adherence, said Paul Ciechanowski, MD, MPH, associate professor at the University of Washington.

The pay-for-performance model has come a long way in terms of how physicians are taking care of larger patients populations, according to Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.