Providers

Michael E. Chernew, PhD; Lee N. Newcomer, MD, MHA; and Sandra M. Swain, MD; examine the treatment benefits, cost concerns, and insurance coverage strategies for pertuzumab.

Earlier this week, Kaiser Health News released an analysis of Medicare data which showed that approximately 2200 hospitals will face penalties this October for having too many patients readmitted for care within 30 days of discharge.

Mark Zitter, MBA, CEO of the Zitter Group, states that oncology pathways can standardize the way care is delivered while improving quality and reducing costs.

Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, states that hospice and palliative care programs are important in the coordination of care for patients.

Much of the focus at AHIP Institute 2012 has naturally been on the issues that affect health plans and payers. However, one session in particular focused on some of the barriers and issues that providers face in today's complex healthcare environment.

To improve formulary design processes and support payers in providing more effective healthcare, policy makers should consider involving commercial payers in the development of comparative effectiveness research and creation of research and treatment guidelines.

Comparative effectiveness research and pragmatic clinical trials are valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by stakeholders.

Journal of Oncology Practice (JOP) and The American Journal of Managed Care (AJMC) join efforts to highlight work focusing on issues affecting payers and providers.

Mr. Geraghty points out a variety of ways to engage a health plan's members.