In This Week’s Issue:
1. CMS Proposes Controversial Medicare Part B Drug Demonstration, see details below.
2. Health Affairs Blog: Measures That Matter — But To Whom?, click here to view the post.
3. LAN Blog: Ensuring the Debate has the Patient in Mind and in the Room, click here to view the blog post.
4. PCORI Blog: Advancing Research by Giving Patients Greater Access to Their Health Data, click here to view the blog post.
5. PCORI Blog: A Multifaceted Disease Requires a Patient-Centered Response, click here to view the blog post.
1. CMS Proposes Controversial Medicare Part B Drug Demonstration, see details below.
2. Health Affairs Blog: Measures That Matter — But To Whom?, click here to view the post.
3. LAN Blog: Ensuring the Debate has the Patient in Mind and in the Room, click here to view the blog post.
4. PCORI Blog: Advancing Research by Giving Patients Greater Access to Their Health Data, click here to view the blog post.
5. PCORI Blog: A Multifaceted Disease Requires a Patient-Centered Response, click here to view the blog post.
1. CMS Proposes Controversial Medicare Part B Drug Demonstration
The Centers for Medicare and Medicaid (CMS) unveiled a highly anticipated Medicare Part B drug demonstration Tuesday to test new approaches to paying for prescription drugs administered in doctors’ offices. Currently, Medicare Part B pays medical providers based on a drug’s average sales price (ASP), plus six percent. Among its proposals, the agency proposes "to use indications-based pricing where appropriately supported by published studies and reviews or evidenced-based clinical practice guidelines, such as the ICER reports, to more closely align drug payment with outcomes for a particular clinical indication.”
The danger of relying on average value assessments for vulnerable patients and people with disabilities was discussed by PIPC Chairman Tony Coelho in his recent opinion in the Huffington Post, available here. PIPC Chairman Coelho stated, "As a lifelong advocate for patients and people with disabilities, I will continue to fight to advance the rights of patients to have informed discussions with their doctors about their options, and to decide on the course of treatment that works best for them. Congress spoke to the centrality of patient-centeredness when it established PCORI to advance a new model of research that centers on the needs of patients and respects patient differences. We should be building upon this foundation and extending it more broadly into health care delivery and decision-making."
Officials are also seeking input from stakeholders on five drug-spending containment policies to be tested for outpatients in the second phase of the pilot, which would begin Jan. 1, 2017. Those policies include (1) paying the same amount for therapeutically similar drugs; (2) discounting or eliminating patient cost-sharing; (3) adjusting payment for drugs based on how well they work; (4) adjusting payment based on the diseases they're prescribed for; and (5) creating prescribing guidelines.
Comments are due by 5:00 p.m. ET on May 9, 2016. The proposal is available here. A CMS press release is available here; see the agency’s fact sheet here. A fact sheet tailored to beneficiary issues and protections is posted here. CMMI has posted preliminary details on the Model on its website.
2. Health Affairs Blog: Measures That Matter — But To Whom?
In a post on Health Affairs Blog, Bruce Siegel, Christine Cassel, and Robert Saunders comment, “The health care and health policy communities are increasingly calling for ‘measures that matter.’ Journal articles and policy reports have highlighted the proliferation of performance measures, and many conferences have focused on reducing the number of metrics to a small set... One notable effort is the CMS-AHIP Core Quality Measures Collaborative, which seeks to align measures across public and private payers. The Collaborative, supported by technical assistance from the National Quality Forum (NQF), has identified core measures for several clinical specialty areas, and further efforts will be needed to identify such measures for additional specialties… There will always be a tension between wanting a small set of measures (that reflect the nation’s top priorities) and patients’ and clinicians’ need for measures reflecting specific uses and conditions.” Click here to view the post.
3. LAN Blog: Ensuring the Debate has the Patient in Mind and in the Room
In blog post from the Healthcare Payment Learning and Action Network (LAN), Patrick Courneya, Executive Vice President and Chief Medical Officer for Kaiser Foundation Hospitals and Health Plan, Inc. and a member of the LAN’s Guiding Committee, explains what the Kaiser Permanente model can teach us about incentivizing physicians and care teams to help improve patient care. According to Courneya, “One prime example of the health benefits that can occur within a model that incentivizes the best interest of the health of the patient is in our work around cardiac care for those patients with diabetes… If the rest of the U.S. managed the blood pressure of hypertensive patients as well as Kaiser Permanente does, many thousands of heart attacks and strokes could be prevented each year, and several hundred thousand deaths could be prevented over 10 years.” Click here to view the blog post.
4. PCORI Blog: Advancing Research by Giving Patients Greater Access to Their Health Data
In a new post on The PCORI Blog, PCORI Executive Director Joe Selby, MD, MPH comments, “Information shared by patients is crucial to meeting PCORI's goal of enhancing the quality, efficiency, and usefulness of clinical research for patients and other end users of the results. We and our PCORnet colleagues believe that the research we support must be informed by the everyday experiences of ordinary patients, so it addresses the questions that matter most to patients and the results are useful and widely applicable. These are the kinds of issues the PCORnet Trustworthiness workshop is designed to address.” Click here to view the blog post.
5. PCORI Blog: A Multifaceted Disease Requires a Patient-Centered Response
In a post last week on The PCORI Blog, Philip Posner, PhD, a member of the Advisory Panel on Patient Engagement, comments, “As both a patient and a former medical scientist, I know that we need patient-centered research to help speed accurate diagnosis and provide evidence that patients and clinicians can use to decide among treatment strategies. I've become involved with both PCORI and the MS Society, which work closely with patients and caregivers to fund projects in this area. PCORI will soon announce major new studies funded through an MS-specific initiative.” Click here to view the blog post.
The Centers for Medicare and Medicaid (CMS) unveiled a highly anticipated Medicare Part B drug demonstration Tuesday to test new approaches to paying for prescription drugs administered in doctors’ offices. Currently, Medicare Part B pays medical providers based on a drug’s average sales price (ASP), plus six percent. Among its proposals, the agency proposes "to use indications-based pricing where appropriately supported by published studies and reviews or evidenced-based clinical practice guidelines, such as the ICER reports, to more closely align drug payment with outcomes for a particular clinical indication.”
The danger of relying on average value assessments for vulnerable patients and people with disabilities was discussed by PIPC Chairman Tony Coelho in his recent opinion in the Huffington Post, available here. PIPC Chairman Coelho stated, "As a lifelong advocate for patients and people with disabilities, I will continue to fight to advance the rights of patients to have informed discussions with their doctors about their options, and to decide on the course of treatment that works best for them. Congress spoke to the centrality of patient-centeredness when it established PCORI to advance a new model of research that centers on the needs of patients and respects patient differences. We should be building upon this foundation and extending it more broadly into health care delivery and decision-making."
Officials are also seeking input from stakeholders on five drug-spending containment policies to be tested for outpatients in the second phase of the pilot, which would begin Jan. 1, 2017. Those policies include (1) paying the same amount for therapeutically similar drugs; (2) discounting or eliminating patient cost-sharing; (3) adjusting payment for drugs based on how well they work; (4) adjusting payment based on the diseases they're prescribed for; and (5) creating prescribing guidelines.
Comments are due by 5:00 p.m. ET on May 9, 2016. The proposal is available here. A CMS press release is available here; see the agency’s fact sheet here. A fact sheet tailored to beneficiary issues and protections is posted here. CMMI has posted preliminary details on the Model on its website.
2. Health Affairs Blog: Measures That Matter — But To Whom?
In a post on Health Affairs Blog, Bruce Siegel, Christine Cassel, and Robert Saunders comment, “The health care and health policy communities are increasingly calling for ‘measures that matter.’ Journal articles and policy reports have highlighted the proliferation of performance measures, and many conferences have focused on reducing the number of metrics to a small set... One notable effort is the CMS-AHIP Core Quality Measures Collaborative, which seeks to align measures across public and private payers. The Collaborative, supported by technical assistance from the National Quality Forum (NQF), has identified core measures for several clinical specialty areas, and further efforts will be needed to identify such measures for additional specialties… There will always be a tension between wanting a small set of measures (that reflect the nation’s top priorities) and patients’ and clinicians’ need for measures reflecting specific uses and conditions.” Click here to view the post.
3. LAN Blog: Ensuring the Debate has the Patient in Mind and in the Room
In blog post from the Healthcare Payment Learning and Action Network (LAN), Patrick Courneya, Executive Vice President and Chief Medical Officer for Kaiser Foundation Hospitals and Health Plan, Inc. and a member of the LAN’s Guiding Committee, explains what the Kaiser Permanente model can teach us about incentivizing physicians and care teams to help improve patient care. According to Courneya, “One prime example of the health benefits that can occur within a model that incentivizes the best interest of the health of the patient is in our work around cardiac care for those patients with diabetes… If the rest of the U.S. managed the blood pressure of hypertensive patients as well as Kaiser Permanente does, many thousands of heart attacks and strokes could be prevented each year, and several hundred thousand deaths could be prevented over 10 years.” Click here to view the blog post.
4. PCORI Blog: Advancing Research by Giving Patients Greater Access to Their Health Data
In a new post on The PCORI Blog, PCORI Executive Director Joe Selby, MD, MPH comments, “Information shared by patients is crucial to meeting PCORI's goal of enhancing the quality, efficiency, and usefulness of clinical research for patients and other end users of the results. We and our PCORnet colleagues believe that the research we support must be informed by the everyday experiences of ordinary patients, so it addresses the questions that matter most to patients and the results are useful and widely applicable. These are the kinds of issues the PCORnet Trustworthiness workshop is designed to address.” Click here to view the blog post.
5. PCORI Blog: A Multifaceted Disease Requires a Patient-Centered Response
In a post last week on The PCORI Blog, Philip Posner, PhD, a member of the Advisory Panel on Patient Engagement, comments, “As both a patient and a former medical scientist, I know that we need patient-centered research to help speed accurate diagnosis and provide evidence that patients and clinicians can use to decide among treatment strategies. I've become involved with both PCORI and the MS Society, which work closely with patients and caregivers to fund projects in this area. PCORI will soon announce major new studies funded through an MS-specific initiative.” Click here to view the blog post.
