- Center on Health Equity & Access
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- Health Care Cost
- Health Care Delivery
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- Value-Based Care
Balancing Value, Pathways, and Innovation in Healthcare
As specialty drug costs, formulary wars, and reimbursement models grab headlines everyday, we need to take a step back and visualize how all of this might impact innovation and whether the patient stands to lose in the process.
Powerful clinical decision support tools harnessing the potential of big data analytics may make it easier for physicians to set their patients on a standardized road to improvement, but the expansion of pre-approved, packed care may be doing more than just lowering costs. In places where bundled payments based on holistic episodes of care has taken root, these evidence-based, standardized clinical pathways may be having a negative impact on innovation and experimentation that can help those patients that fall outside of treatment methods that receive a payer stamp of approval.
While precision medicine, genomics, and personalized care are becoming big talking points in the research community, is the trend towards financial rewards for a relatively narrow band of evidence-based medicine limiting discovery by making less common treatments too expensive to use routinely?
Link to the complete article on HealthIT Analytics:
Exploring Racial, Ethnic Disparities in Cancer Care Prior Authorization Decisions
October 24th 2024On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.
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