Viewpoints

Michael Schlosser, MD
Ronald Chamberlain, MD
Marcus Dortch, PharmD
When new pharmaceutical products enter the market, the lack of real-world experience with these drugs creates quandaries for payers and providers alike. Often, all there is to go on is the minimum required for FDA approval—non-inferiority to a comparator product in terms of efficacy and safety. Here are a few promising strategies to end this ambiguity.

Zachary Hafner
Advisory Board

Zachary Hafner
Building integrated cancer care programs is worth the effort. On the funding front, two key trends have particular relevance to the development: continued growth in the self-funded employer market, and booming expansion of Medicare Advantage. Both shift financial risk from traditional stakeholders to new ones.
Zachary Hafner
It’s going to take a lot of work. The good news is that great progress is already being made. As technology and consumer expectations continue to evolve, we can expect virtual care to play an increasingly important role in ushering in truly integrated care.

Zachary Hafner
Advisory Board

Zachary Hafner
Long at odds, the interests of payers and providers are becoming more compatible and aligned. Both stakeholders need to collaborate to manage costs. Encouraging use of generics and biosimilars is one way they can slow down the soaring drug spend.

Barbara Antuna, MD

Barbara Antuna, MD
Efforts to improve patient communication must become a priority. Too often, the language we use in health care is a kind of code that serves billing and other purposes. Jargon may be an efficient and precise way for insiders to communicate, but it is impossible for patients to understand.
Paul Terry

When House Speaker Paul Ryan describes what he thinks should replace the Affordable Care Act, he says health care needs to be more patient centered. He is not espousing the long-held view among clinical professionals that patient-centered care ensures that patient preferences and values guide clinical decision-making à la the Institute of Medicine’s (IOM) definition. Instead, Ryan defines patient-centered health care as a set of policy changes that will result in lower costs, more insurance coverage options, and greater control over where someone can receive health care.

Zachary Hafner
In an age of consumerism and heightened attention to the whole patient across a broader continuum of care, organizations that support the availability of a broad set of sexual health services to a diverse group of consumers will have a big competitive advantage, but they may face challenges balancing the costs.
Michael Schlosser, MD
Felix Lee, MD
There are some success stories. Lowe’s pioneering flat-rate deal with the Cleveland Clinic for heart surgery has shown both cost savings and quality improvement. Other large employers, notably Walmart and PepsiCo, have followed suit, signing contracts with self-described, single-hospital “centers of excellence” for a handful of elective procedures.

Carter Paine
naviHealth

Carter Paine
Areas of the country with high concentrations of long-term acute care hospitals or inpatient rehabilitation facilities often have much higher utilization rates, even if a skilled nursing facility or home health provider could provide care comparable in quality and at a much lower price.

Zachary Hafner
Advisory Board

Zachary Hafner
For both providers and payers, the time, effort, and resources dedicated to collecting and reporting data is exorbitant. While most reporting requirements are well intentioned, the proliferation is not adding value and—in some circumstances—does more harm than good.
Jason Duhon
CMS depends on encounter data submitted by state Medicaid programs to maintain the massive Medicaid Statistical Information System (MSIS), a database of claims, encounter data, and beneficiary eligibility information. Poor encounter data can hinder quality measurement in multiple ways.
Ted Slafsky, MPP & Robert Chapman, MD

In an era of rapidly escalating prices, the 340B drug discount program remains one of the few checks to keep medicine and medical care accessible to the underserved. Contrary to the recent column, "Payers Must Develop Strategies To Overcome 340B Hurdles," it is not being exploited by participating hospitals. If it were, where exactly is the money?

Zachary Hafner
Advisory Board

Zachary Hafner
If you’re still bickering over rate hikes and contract minutiae, then you’re out of step with the new health care economy. In progressive markets, savvy payers and providers that work together rather than constantly bumping heads are pulling ahead at the expense of slow movers and status quo players.
Chuck Hayes

Nearly half (45%) of American adults have a chronic health condition and a quarter have more than one chronic illness. Patients readily admit they do a better job of taking care of themselves when they receive reminders and motivational messages from their health care providers.

Zachary Hafner
Advisory Board

Zachary Hafner
The transformation of health care is fundamentally altering the environment in which health systems function, placing the CMO squarely at the center of a new reality where concepts like value, population health management, and outcomes-based payment are becoming key drivers of success.