Paul Terry

President and CEO, HERO

Lessons we’re learning from both companies and communities show that it takes a revolutionary mindset to advance a culture of health. Looking at the color of the food in your cafeteria just might be the best place to start.
Anand Natampalli and Daniel A. Schulte
What does the new marketplace look like? A critical aspect of engaging members and patients is delivering a unified, seamless experience across the channels or devices of the members’ choice, be it via smartphone, laptop, landline, email, or online chat.
Jan Greene
HIMSSWith the exception of Kaiser, health insurers sent relatively small contingents to this year's annual HIMSS annual meeting, which is being held in Las Vegas this week
Paul Terry, CEO, Heath Enhancement Research Organization
Paul Terry, CEO, Health Enhancement Research Organization

There are two transformations occurring in workplace based health promotion in America. The first is the movement from wellness to “well-being” and, related to this, a shift from a focus on a return on investment (ROI) to the use of value on investment (VOI) measures. These VOI measures are well documented and publicly available, but are we thinking broadly enough?

This month, my organization, the Health Enhancement Research Organization (HERO) hosted a contingent from Tokyo University and the Mitsubishi Research Institute. HERO is a not-for-profit research organization that has collaborated with Mercer to create a national employee health and well-being scorecard about which our Japanese guests were eager to learn. 

Paul E. Terry, PhD

Limiting access to any pleasures: tobacco, foods that are bad for you, the after-party of a Prince concert—you name it, you’re going to be unpopular with many people.  To quash what some see as their right and none of your business is to invite endless arguments that as often as not have little to do with the facts of the matter.  As someone who has weighed in on my share of health policy debates, I’ve long observed that the “greatest good for the greatest number” bromide calms my nerves, but it seldom holds sway with those who don’t see what good the policy is doing them.  

I recently had the pleasure of teaming up with Dr. Laurie Whitsel, her colleagues at the American Heart Association, and top tobacco control and prevention experts in drafting “Guidance to Employers on Integrating E-Cigarettes/Electronic Nicotine Delivery Systems into Tobacco Worksite Policy.”  Developing the policy proved to be a tour de force review of the facts on the matter as well as a thorough immersion into discussions about private choices versus public policies.  

The paper was recently published in the Journal of Occupational and Environmental Medicine. You can get a full-text PDF of it here.

Richard Mark Kirkner

In their decision to uphold tax subsidies for policies sold on the federal health insurance exchange established by the Affordable Care Act (ACA), the Supreme Court Justices showed a keen understanding of the history of various state health reform measures and how insurance markets operate in general, invoking terms like community rating, adverse selection and death spiral.

Norman S. Ryan MD

Estimates show that 64% of the Medicare population and 72% of commercial and Medicaid plans have at least one care gap. We know that care gap reductions can lead to improved health outcomes and increased patient satisfaction, which can, in turn, improve quality measures.

Implementation of health management programs is helping health plans improve scores in the prevention, chronic condition management, and patient satisfaction categories, but overall improvement is highly dependent on engaged and satisfied members.

While there are two primary goals of disease management programs—to educate and inform and to motivate behavior change—the traditional model focuses more on the former and less on the latter.

If motivation and behavior rarely become the focus of systematic intervention, then it will be difficult for members to do their part in closing their own care gaps. What results is what we often see—a less meaningful impact on members’ health, healthcare utilization, and healthcare cost reduction.

If health outcomes are going to improve, members need help with changing behaviors.

Ted Slafsky

Contrary to the highly misleading picture painted by critics, the 340B drug discount program is working as Congress intended and helping millions of underserved Americans receive better healthcare every year.

The pharmaceutical industry has gone to great lengths to misconstrue how the program functions in an effort to vilify safety-net hospitals. These are the urban and rural facilities across the country that care for all patients, regardless of their ability to pay.

Frank Diamond

They are relatively cheap to develop, since clinical trials are small and “the lack of alternative treatments give orphan agents an advantage when up for regulatory review,” according to a report by Evaluate, a life science market intelligence company that provides forecasts on that sector. The company’s second annual EvaluatePharma Orphan Drug Report says that orphan drug sales will make up 19% of prescription drug sales by 2020, totaling about $176 billion.

Insurers will have their hands full because even though the populations that need orphan drugs are small “they represent big per-patient outlays, and insurers will be looking carefully at new tools to arrest cost growth as more and more orphan drugs launch,” says the study. The cost per orphan drug per patient is six times that of non-orphan drugs.

Worldwide Orphan Drug Sales & Share of Prescription Drug Market (2000-20)

Average Cost per Patient per Year 2010-14

Source: “EvaluatePharma Orphan Drug Report 2014,” Evaluate 

Norm Ryan, MD
Norm Ryan, MD

As the healthcare industry continues the shift toward value-based medicine, Medicaid plans and providers have two clear avenues to pursue in demonstrating success in managed care and population health that can improve their HEDIS scores: