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.
Complex care management programs that work adapt to local caseloads and conditions, coordinate with primary care practices, and focus on building trust with patients. A multidisciplinary team could include a PCP, care manager, social worker, pharmacist, and even a geriatrician and nutritionist.
Health plans have to gauge the value of genetic and genomic tests. One of the problems is that the quality of information on genes and variants in the existing databases varies widely, with more recent reports generally containing better information than early test results.
Regeneron’s aflibercept (Eylea) injection in patients with diabetic macular edema demonstrated greater improvement in visual acuity than either of two Genentech biologics, bevacizumab (Avastin) and ranibizumab (Lucentis).