- FINAL DAY TO SIGN! PIPC/AAPD Letter Opposing Use of CER and Cost-Effectiveness in Medicare, click here to view the current list signatories and here to view the comment letter.
- PIPC Call to Action: Grassroots Campaign to Oppose National Cost-Effectiveness Thresholds in Medicare, see details below.
- PIPC/AAPD in Wall Street Journal: Lawmakers Criticize Medicare Plan for Costly Drugs, click here to view the article.
- U.S. News: The New Health Care Rationing, click here to view the article.
- AJMC: Inculcating the Patient Voice in the Development of Value Models, click here to view the article.
- Kaiser Health News: Patients’ Assessment Of Their Health Is Gaining Importance In Treatment, click here to view the article.
- Health Affairs: Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care, click here to view the article.
- National Forum for Heart Disease and Stroke Prevention Launches Value and Access Initiative, see details below.
The Partnership to Improve Patient Care (PIPC) and the American Association of People with Disabilities (AAPD) is proud that we have over 50 signatures on our letter urging policymakers not to move forward with proposals to tie Medicare policy to cost effectiveness reports and average value assessments that reflect a “one-size-fits-all” attitude toward patients and people with disabilities. No patient is average. Today is the deadline for comments to CMS on the proposed Part B Drug Payment Model so let us know as soon as possible if your organization wants to sign on as well! With a united voice we can stop CMS from setting a dangerous precedent that threatens Medicare’s most vulnerable beneficiaries, namely patients and people with disabilities. We cannot allow the agency to bypass the Affordable Care Act’s protections against use of quality-adjusted-life-years (QALYs) and use of comparative effectiveness research to limit access to care through its Innovations office. Today’s Politico Pulse also highlights the PIPC/AAPD letter and its opposition to the changes in phase 2 of the proposal. Click here to view the current list of organizations signing our letter. Click here to view the comment letter.
2. PIPC Call to Action: Grassroots Campaign to Oppose National Cost-Effectiveness Thresholds in Medicare
The Partnership to Improve Patient Care (PIPC) is calling on all members and patient advocates to engage their grassroots networks in opposition of a new proposal calling for centralized use of comparative effectiveness and cost-effectiveness reports as the basis for national Medicare policy. As detailed in our recent Patient Access Alert, PIPC is strongly opposed to CMS’ new Part B emonstration; by relying on value assessment tools intended to drive centralized coverage decisions, it creates substantial new barriers to patient access and undermines the movement toward patient-centered health care.
To make it easy for stakeholders and patients to express their opposition to the proposal, PIPC has set up a new comment portal and has prepared the action alert below to encourage grassroots support for our position. Our goal is to generate hundreds of letters to Members of Congress to demonstrate the significant resistance among the patient community to CMS new proposals. PIPC strongly encourage our members and friends to share the action alert below with their networks – via email blasts, blog posts, newsletters, on websites, and using social media – to encourage stakeholders to spend two minutes contacting their Member of Congress and opposing the Part B demonstration.
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Stop Medicare from Getting Between Patients and Their Doctors!
We need your help! Last month, the U.S. Medicare agency (CMS) proposed a new reimbursement model for prescription drugs that would set a troubling precedent for determining what treatment options a doctor can offer their patient.
>> Click for easy instructions on how to comment <<
This new proposal would allow the government to determine the value of certain drug treatments for patients by using generalized “comparative effectiveness” research and “cost-effectiveness” data which focus on treating the “average” patient. In reality, no patient is average, and reimbursement policies that rely on treating the “average” patient consistently fall short in facilitating a patient-centered approach to care that allows doctors and patients to collectively choose the best treatment options.
Comparative effectiveness research can be used as a valuable tool for patients to better understand their treatment options and the impact on outcomes they care about so that they can make informed decisions with their providers. However, proposals that set national coverage policies based on bureaucratic determinations of average value pose a grave risk to patients. As proposed, Medicare could use academic research against patients to limit coverage to a treatment that is deemed “cost-effective,” regardless of the real impact on patients or their personal preferences for their course of treatment.
>> Tell Congress: Don't let Medicare get between patients and their doctors <<
The voice of the patient community will be essential in urging Congress to stop Medicare from setting up this new reimbursement model that could significantly undermine the ability of patients and doctors to choose the most appropriate treatment method. We urge you to take two minutes to visit the Action Center and submit comments to Congress to encourage them to support patient-centered care and uphold the doctor-patient relationship.
3. PIPC/AAPD in Wall Street Journal: Lawmakers Criticize Medicare Plan for Costly Drugs
According to a new article in the Wall Street Journal, lawmakers in Congress and leading healthcare stakeholders—including PIPC—have raised concerns with CMS’ recent proposal on Medicare Part B drug reimbursement. “Concerns also are surfacing about a second stage of the proposal that would test alternative payments for drugs, including payments based on a treatment’s effectiveness. For example, CMS suggested the use of reports from a nonprofit group, the Institute for Clinical and Economic Review, known as ICER. Those reports analyze the cost-effectiveness of drugs, and some incorporate a metric known as Quality-Adjusted Life Year, or QALY, which quantifies the health benefit and quality of life derived from a particular treatment. The findings have been used by some insurers in coverage and reimbursement decisions. ‘It is unimaginable that we would allow public programs to incorporate the use of QALYs as is being proposed,’ according to a comment letter led by the Partnership to Improve Patient Care and the American Association of People with Disabilities.” Click here to view the article.
4. U.S. News: The New Health Care Rationing
As reported last week in U.S. News, “many insurance companies and pharmacy benefit managers, protective of their bottom line, are finding ways to restrict coverage despite the drugs' effectiveness. One tactic is to require that an existing cheaper drug be prescribed rather than the new, potentially more effective drug. This process, called step therapy, has been widely criticized by patient groups and physicians alike. Or, instead of excluding the drug outright, payers often pile on onerous, bureaucratic red tape such as so-called prior authorization requirements, which make it much harder for patients to access new drugs. How do payers justify these hurdles? One way is to strategically deploy allies in the health care nonprofit world to camouflage their decisions under the cloak of economic analysis. A key example is the Institute for Clinical and Economic Review, which recently began conducting analyses to determine whether a new drug's benefit is worth its cost. It has found most of the drugs it has reviewed to be too expensive, giving insurance companies and pharmacy benefit managers an excuse to restrict them.” Click here to view the article.
5. AJMC: Inculcating the Patient Voice in the Development of Value Models
In an article published last week in the American Journal of Managed Care (AJMC), National Health Council’s Mark Boutin discusses the Patient-Centered Value Model Rubric. “Value models (also known as frameworks) have emerged as the latest tools to help healthcare stakeholders assess the worthiness of new treatments. But who defines what is of “value” in healthcare? What are the criteria for determining that a drug or treatment is valuable? And valuable to whom? In 2015, 4 organizations—the American Society of Clinical Oncology (ASCO), the Institute for Clinical and Economic Review (ICER), the National Comprehensive Cancer Network (NCCN), and Memorial Sloan Kettering Cancer Center—released frameworks that the developers described as intended to support physicians and/or payers in assessing the value of treatments. However, value means different things to different people, and subsequently, establishing a definition of value that is broadly supported across the healthcare system has been elusive… We need robust processes in place to incorporate the patient voice into the development of value models. Such action is particularly urgent if physicians and payers look to these frameworks to inform decisions that can affect the treatment options available to a patient.” Click here to view the article.
6. Kaiser Health News: Patients’ Assessment Of Their Health Is Gaining Importance In Treatment
An article last week in Kaiser Health News highlights the growing trend of incorporating patient assessment of heath into care decisions. “It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data has traditionally been confined to research rather than clinical settings. Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care. However, as patient-centered medical care has taken hold in recent years, there’s been a growing interest in finding ways to use outcomes reported by individuals to help guide care.” Click here to view the article.
7. Health Affairs: Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care
As detailed last week in Health Affairs, “The provision of patient-centered care requires a health care environment that fosters engagement between patients and their health care team. One way to encourage patient-centered care is to incorporate patient-reported outcomes into clinical settings. Collecting these outcomes in routine care ensures that important information only the patient can provide is captured. This provides insights into patients’ experiences of symptoms, quality of life, and functioning; values and preferences; and goals for health care. Previously embraced in the research realm, patient-reported outcomes have started to play a role in successful shared decision making, which can enhance the safe and effective delivery of health care. We examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. We highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, we examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic.” Click here to view the article.
8. National Forum for Heart Disease and Stroke Prevention Launches Value and Access Initiative
As detailed in a release from the National Forum for Heart Disease & Stroke Prevention, “Patient access and adherence to effective therapies are major concerns in the cardiovascular disease space. To address these issues, the National Forum for Heart Disease & Stroke Prevention, with a cohort of influential cardiovascular health leaders and patient advocates, will develop consensus messaging to unite our focus, bind our commitment, and activate advocacy and action on patient access and the value of medical therapies. The consensus messaging will focus on value and access because patient access to providers and therapies, as well as different perceptions around value, has posed a significant barrier to adherence within the U.S. Our goal is to empower a collective voice that elevates the focus on appropriate access to therapies and their value to patients. For more information or to get involved with this initiative, please contact John Clymer at firstname.lastname@example.org.