Interviews

There are a number of areas where pharmacy benefit managers can help support employers with the high-cost of specialty pharmacy drugs, but so far they have only been doing a good job in some priority areas, said Bruce Sherman, MD, FCCP, FACOEM.

The 17% decline in hospital-acquired conditions from 2010 to 2014 is the result of a decades long campaign and means lives saved, the avoidance of pain and suffering, and less costly care, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

The current dialogue occurring between payers and providers is critical in today's healthcare environment, and it's an interaction that certainly was not happening just 5 or 6 years ago, according to Ted Okon, executive director of the Community Oncology Alliance.

Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Oncology, like primary care, is ripe for delivery reform, but it has remained stuck in a fee-for-service mindset, said Kavita Patel, MD, fellow in economic studies and managing director at Brookings Institution.

The Patient-Centered Outcomes Research Institute (PCORI) will approach biosimilar research the way it does research on anything else, but there is the added element of finding the right timing, said Joe V. Selby, MD, MPH, executive director of PCORI.

Glen D. Stettin, MD, senior vice president of clinical, research, and new solutions at Express Scripts, discusses what strategies for managing high-cost treatments aren't working and how they could be improved.

Patients considering using a genetic test should meet with a genetic counselor first to get a better understanding of the patient's goal for getting the test done and determine the likelihood that a test might be useful, explained Joy Larsen Haidle, MS, CGC, president of the National Society of Genetic Counselors.

The future of patient engagement in healthcare will be mobile, which should also help reduce healthcare disparities as more and more less-fortunate groups adopt smartphones, said Joseph C. Kvedar, MD, vice president of Connected Health at Partners HealthCare.

If the FDA steps in to regulate laboratory-developed tests, it will slow down innovation, add costs to the development of the product, and likely decrease the number of tests that come out, but the public health benefits of increased oversight might be worth it, said Scott Gottlieb, MD, resident fellow at the American Enterprise Institute.

While the 340B Drug Pricing Program was designed to help facilities that take care of impoverished patients with low-cost drugs, what the program has morphed into is almost the opposite of what it was intended to do, said Peter Bach, MD, MPP, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes.

While the FDA could regulate diagnostic tests the way they are in Europe-through simple verification that the test is accurate-the FDA has not chosen to do that and comes closer to requiring clinical utility, explained Bruce Quinn, MD, PhD, senior director at FaegreBD Consulting.

Julie M. Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology (ASCO), and keynote speaker at this year's Patient-Centered Oncology Care meeting, discusses addressing cost of care, using value calculators, and the Medicare Access and CHIP Reauthorization Act.

The future of medicine will be creating partnerships with other providers and other healthcare organizations that are like-minded and looking to enter into value-based modes of care to create networks taht aren't narrow but are coordinated and high performing, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

After the Supreme Court struck down gene patents, not only is more genetic testing is being offered, but the technology of the test has expanded to the benefit of patients, said Joy Larsen Haidle, MS, CGC, president of the National Society of Genetic Counselors.

Throughout 2015, as The American Journal of Managed Care celebrated 20 years, the publication invited key healthcare industry leaders to write special guest commentary, which appeared each month in the journal.

The new opioid measures from the Pharmacy Quality Alliance (PQA) are supposed to compare opioid dosages across organization to attempt to get a handle on the issue of opioid addiction, said Woody Eisenberg, MD, senior vice president of performance measurement and strategic alliances for the PQA.

There needs to be more transparency in the healthcare industry because even though there is currently information available on health plans and hospitals, it's often not information that is useful to consumers or purchasers, explained Leah Binder, MA, MGA, president and chief executive officer of The Leapfrog Group.

Historically cancer survivorship programs have not emphasized cardiac follow-up and there is not a lot of long-term data on cardiac toxicity in patients who received certain drugs, but that is changing as patients live longer and fuller lives after treatment, explained Crystal S. Denlinger, MD, from the Fox Chase Cancer Center in Philadelphia.

The Better Medicare Alliance works to articulate the value of Medicare Advantage and the way it has improved access to care and the right kind of care for millions of beneficiaries, said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance.

When accountable care organizations first started forming, the country thought it would be easier than it has been, but finding the right partner is crucial, said Pam Halvorson, regional vice president of clinic operations with Trinity Pioneer ACO.

As patients with cancer live longer and the disease becomes a chronic disease for many, it becomes important for providers to understand how the needs of the patient change from being newly diagnosed to active therapy to long-term therapy, explained Linda House, president of the Cancer Support Community.

The US horizon scanning system is more comprehensive than the one used in Europe, but the US has the disadvantage of having a more fragmented healthcare system, explained Elise Berliner, PhD, director of the Technology Assessment Program in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality.

Julia Adler-Milstein, PhD, was named the first winner of the Seema S. Sonnad Emerging Leader in Managed Care Research Award at the 20th anniversary event for The American Journal of Managed Care, held October 28 in Orlando, Florida. Ashish K. Jha, MD, professor of health policy at the Harvard T.C. Chan School of Public Health, nominated her for the award and explains why he believes she is an Emerging Leader and the importance of this award.

Patients, especially those with complex chronic conditions, factor in a lot of different things when making care decisions, and increasingly cost is a huge issue, said Marc Boutin, JD, chief executive officer of the National Health Council.

As the healthcare industry moves toward population health and improving quality and value, The American Journal of Managed Care (AJMC) is in a good position to help lead the change, according to Rose Maljanian, RN, MBA, chairman and chief executive officer of HealthCAWS and a member of the AJMC editorial board.

Getting health information technology (IT) to work in one provider system can be difficult enough, but in ACOs, they have multiple systems on different platforms, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Measuring quality of life in oncology care is difficult for a number of reasons, but Laura Long, MD, MPH, president at TheLongView, PC, expects that to change in the future.

The shift to a pay-for-performance environment healthcare gets the provider more involved with the patient, which has a greater impact on quality measures like adherence, said Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

There has been tremendous momentum in the value-based insurance design movement in the US healthcare industry, but there are 3 specific ones that are noteworthy, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.