Value assessment in general, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending. Currently, the most common method for determining incremental cost-effectiveness of healthcare interventions is based on a calculation of quality-adjusted-life-years (QALYs). While the model has a basic appeal for making population-level decisions (by reducing patient populations to single, aggregate numeric values), it also poses several significant concerns from the vantage point of patient-centeredness and efforts to preserve access to needed care for individual patients and people with disabilities. Of particular concern to me are the implications of use of QALYs for discrimination against people with disabilities, and its conflicting goals from the goals of personalized medicine.
In a letter to the Health Care Payment and Learning Action Network’s (LAN), PIPC applauds revisions made in the second draft of their Alternative Payment Model (APM) framework, while also raising concerns about the process and timeline to provide input. In the letter PIPC supports the fact that the new draft does not rely on cost effectiveness reports as a pillar for defining patient-centeredness in APMs. Additionally, PIPC strongly supports revisions made to move beyond damaging cost-effectiveness thresholds, and appreciates LAN's recognition of the importance of considering the risk of unintended consequences in APM design.