The $1,000 pill a patient takes today for hepatitis C will hopefully prevent the $580,000 liver transplant down the road. It’s not a matter of simple math, however, and weighing the cost and benefit can be frustrating. For one thing, there’s the issue of patient churn.
In 1914, Henry Ford nearly doubled his workers’ pay to $5 a day, guaranteeing a whole new market for his cars. Cars aren’t drugs, and health plans are faced with the problem of how to give access to miracle medications without bankrupting patients with out-of-pocket costs.
Always controversial. “The idea that ACOs work and multiply and somehow evolve into capitation is just a mass hallucination. It isn’t going to happen.” What is happening, he says, is one of the most favorable contracting environments insurers could ask for.