The Cleveland Clinic has joined with the Internet giant Google to test a secure exchange of patient medical record data involving prescriptions, conditions, and allergies. The exchange will occur between the patient’s electronic personal health record housed at the clinic and a secure Google profile that could be accessed, for instance, in a doctor’s office or a hospital. The ultimate goal of this experiment, in which the patient controls the flow of information, is to give patients the ability to interact with multiple physicians, health care providers, and pharmacies.…. A regulation to establish patient safety organizations (PSOs) has been promoted by the U.S. Department of Health and Human Services. PSOs are private entities that would collect and analyze patient safety events reported by health care providers. Under the proposal, a hospital could describe in detail how the wrong leg happened to be amputated without fear of being hit with a lawsuit (at least as a result of this exchange of information). Under the proposal, PSOs can collect, aggregate, and analyze data, and provide feedback to help providers and health care organizations improve health care quality.…. America’s Health Insurance Plans is pushing a proposal with state insurance regulators that would give consumers the right to appeal policy rescissions based on an insurer finding out that the patient had a pre-existing condition that had not been disclosed during initial enrollment. The proposal would call for individual states to use independent panels of health care professionals and lawyers to review such cancellations. Details of how the process would function hadn’t been finalized, the group said at press time, so stay tuned. — Tony Berberabe
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
If millions of Americans lose Medicaid or private health insurance coverage because of the unACAing of American health care, telehealth may seem like a gimmicky sideshow rather than a good-faith effort to bring health care into the digital century.