Aimovig and other drugs targeting the CGRP neuropeptide aim to prevent migraines in a whole new way. But Aimovig’s cost may mean an obstacle course of prior authorization and step therapy.
It is finally starting to happen. The first gene therapy to treat an inherited disease is out of the gate. But my, that price tag: $850,000. Many more gene therapies are on their way. How can they be priced to hit the sweet spot of affordability, access, and innovation? Outcomes-based pricing doesn’t really do the trick.
And that means full scope of practice as primary care providers. Medical societies hate the idea and think that nurse practitioners need to be tethered securely to a physician office in order to ensure top-notch care. Nurse practitioners counter that they can help shore up primary care.
The pay-for-value movement could justify rewarding—and punishing—doctors based on quality scores. Problem: Hardly anyone likes the current ways quality is measured, especially physicians. Few believe that Medicare’s Merit-based Incentive Payment System (MIPS) will clear things up. In fact, it might cause more confusion.
Genetic testing has taken off and may usher in a new era of genetically tailored health care. Insurers are figuring out how to cope with the avalanche of information. Could genetic counselors as standalone practitioners be part of the answer?
Develop a formulary that rules out wasteful medications.
At first patients didn’t care that much. Then the monitors improved, and studies showed improved outcomes. But CMS wouldn’t cover them unless they had a ‘nonadjunctive’ indication. Now some envision a time when fingersticks will be a thing of the past for many people with diabetes.
A report detailing clinic-level cost and quality of cancer care in Washington State is a first—adding its own stamp on efforts to measure value in oncology.
Give away healthy breakfasts and dinners to people with diabetes and it will help them control their disease.
For some, it might be more convenient—and it’s less costly. Why don’t more patients give peritoneal dialysis a try?
The United States spends more—close to double—on health care per capita than other rich countries. By many measures, we’re not getting a good return on those trillions of dollars.
Integrated care models can foster the kind of collaboration that’s needed to treat complex, multifaceted problems like chronic pain. They are among our best hopes for an alternative to the overuse of prescription painkillers that has caused so much suffering and early death.
The authors of Understanding Value-Based Healthcare provide this rationale for their book in terms of how to go about improving health care: “Government cannot do it. Payers cannot do it. Regulators cannot do it. Only the people who give care can improve it.”