Interviews

While the ongoing healthcare debate in Congress creating a lot of uncertainty among the healthcare industry, there are areas of certainty and optimism, said Dan Todd, JD, principal at Todd Strategy.

Despite the politics involved in healthcare, it seems unlikely that the industry to going to stop its migration toward more accountability for quality, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

As the healthcare industry moves more toward value-based payments, practices have a real need for data that is usable and can help them succeed in new payment models, Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care, explained at OncoCloud '17, held by Flatiron Health September 16-17 in Las Vegas, Nevada.

Although direct spending on primary care is low compared with other areas in healthcare, spending on innovations in primary care is important, explained Charlie Fazio, MD, senior vice president and medical director of HealthPartners.

There are a number of challenges with implementing value-based payment models in oncology, but it's an exciting time and offshoots of the Oncology Care Model (OCM) can "revolutionize" cancer care delivery, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team, discusses how Medicare will address and possibly change its biosimilar policies as the FDA offers more guidance and as biosimilars become more prevalent in the market.

Having employers and accountable care organizations agree on expectations is necessary for better alignment of care offered, explained Brian Marcotte, president and CEO of the National Business Group on Health.

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses off-label communications and how coverage determinations are changing along with the production of new immunotherapy agents.

High drug prices have created barriers to accessing medications, and Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health, suggests that the pricing algorithms need to change in order to improve this dilemma.

Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, explains how previous experience with alternative payment models helped a smooth transition into the Oncology Care Model (OCM).

States are addressing biosimilars in different ways and putting different regulations in place as biosimilars become more prevalent in the market, explained Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team.

There are 3 different areas of healthcare that all face different challenges in implementing population health and adopting new reimbursement models, explained Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Charlie Fazio, MD, senior vice president and medical director of HealthPartners discusses how to balance different payment models in order to understand their impacts on cost and patient outcomes when they are implemented.

AJMC caught up with several healthcare professionals at a New Jersey airport before they took off for Houston to help out in the aftermath of Hurricane Harvey.

If physicians had better data systems with better information within their practices, then they could provide more accurate results and improve the care for the patient, explained Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare.

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