Partnership to Improve Patient Care

  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Action Center
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • News
    • Press Releases
    • PIPC in the News
    • PIPC Weekly Update
    • PIPC Patients' Blog
    • Chairman's Corner
    • The Data Mine
  • Events
    • Nevada AB 259
    • QALY Panel
    • QALY Briefing
    • Past Webinars >
      • MFN/IPI Webinar 2025
      • Discrimination & Health Care
      • C & GT Webinar
      • ICER COVID Webinar
      • Value Our Health Briefing
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2023
      • 2022
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010
  • Home
  • About
    • Mission and Priorities
    • Meet the Chairman
    • Steering Committee
    • PIPC Member List
    • Contact
  • The Issues
    • Action Center
    • Value Our Health
    • International
    • Where We Stand
    • Value Assessment Frameworks
    • Engaging Patients in Value-Based Payment
    • Patient-Centeredness in Research
  • Resources
    • Advocacy
    • Letters and Comments
    • PCORI Meeting Transcripts
    • Polling
    • Roundtables
    • White Papers
  • News
    • Press Releases
    • PIPC in the News
    • PIPC Weekly Update
    • PIPC Patients' Blog
    • Chairman's Corner
    • The Data Mine
  • Events
    • Nevada AB 259
    • QALY Panel
    • QALY Briefing
    • Past Webinars >
      • MFN/IPI Webinar 2025
      • Discrimination & Health Care
      • C & GT Webinar
      • ICER COVID Webinar
      • Value Our Health Briefing
      • ICER SCD Webinar
      • VOH Sickle Cell Webinar
      • Rare Disease Webinar
      • QALY Webinar
      • PCORI Advocacy Webinar
      • APM Webinar
      • Patient Empowerment Webinar
      • Value Assessments Briefing
    • Past PIPC Forums >
      • 2023
      • 2022
      • 2021
      • 2020
      • 2019
      • 2018
      • 2017
      • 2016
      • 2015
      • 2014
      • 2013
      • 2012
      • 2011
      • 2010

The PIPC Blog

PIPC Weekly Update: September 24, 2018

9/24/2018

 
Picture
In This Week’s Issue:
 
1. Over 90 Stakeholder Groups to CVS: Don't Discriminate on Care, see details below.
2. Forbes: Will CVS Caremark Make ICER The American NICE? Click here to read the column. 
3. Health Affairs: Blogs on CVS Caremark use of QALY Thresholds to Withhold Coverage, see details below.
4. Mental Health America: 2019 Call for Proposals is Now Open, click here for details
5. Don’t Miss a Beat: The Latest on Heart Valve Disease Research and Policy, see details below.
6. Beyond Opioids: Evidence-Based Delivery of Alternative Treatments for Chronic Pain, click here for details.  
7. Other Upcoming ICER Studies: Angiodema, Asthma, Opioid Use Disorder, click here to provide patient input.
8. GHLF: A Patient’s Guide to Insurance Enrollment, click here to view.   
9. Medical Xpress: Patient-Centered Visual Aid Helps Physicians Discuss Risks, Treatments With Parents, click here to read the article. 
10. 2018 Health Care Payment Learning and Action Network (LAN) Fall Summit, click here to register. 
11. 2018 PCORI Annual Meeting, click here for details.
12. Upcoming Events and Webinars, see details below.
13. Medical Journal Articles, see details below.
14. AHRQ Effective Program Updates, see details below. 

1. Over 90 Stakeholder Groups to CVS: Don't Discriminate on Care
 
​More than 90 leading stakeholder organizations representing patients, people with disabilities, physicians, and caregivers wrote a letter to CVS Caremark in opposition to a new policy that would discriminate against individuals with disabilities and chronic illnesses.
 
In August, CVS announced that they would offer new insurance plans that exclude drugs if they exceed a subjective “cost-effectiveness” threshold. CVS would rely on a deeply flawed value assessment model developed by the Institute for Clinical and Economic Review (ICER) in determining whether treatments fall below a $100,000 “cost per quality-adjusted-life-year” limit. This type of cost effectiveness analysis discriminates against people with disabilities and other vulnerable groups like the elderly because it assigns higher value to people in “perfect health” than people in less-than-perfect health. ​As the letter states, "policy decisions based on cost-effectiveness ignore important differences among patients and instead rely on a single, one-size-fits-all assessment. Further, cost-effectiveness analysis discriminates against the chronically ill, the elderly and people with disabilities, using algorithms that calculate their lives as 'worth less' than people who are younger or non-disabled."
 
The letter goes on to point out that "CVS Health’s stated purpose is 'helping people on their path to better health.' Reliance on cost-effectiveness thresholds like ICER’s falls short of this purpose, replacing deeply personal, individual health care decisions with an opaque algorithm based on average study results that do not address the needs of different patients and special populations.” Click here to read the letter, and click here to track continuing coverage of our campaign against coverage policies that discriminate against people with disabilities and serious chronic conditions. 
 
2. Forbes: Will CVS Caremark Make ICER The American NICE?
 
In a column for Forbes, Joshua Cohen criticizes CVS Caremark’s use of the ICER’s QALY metric in its drug coverage practices. CVS Caremark intends to institute a $100,000 per QALY threshold above which it would deny patient access. Specifically, CVS Caremark will “allow clients to exclude any drug launched at a price greater than $100,000 per QALY from their plan.” Additionally, the white paper notes that drugs deemed "breakthrough" therapies by the Food and Drug Administration will be excluded from a cost per QALY assessment. Rather, CVS Caremark says it will focus on "expensive, ‘me-too’ medications that are not cost effective." The latter statement is puzzling because ICER evaluates newly approved drugs, many of which are not "me-too." It's also presumptuous because there are many expensive drugs that are cost-effective. Click here to read the column. 
 
3. Health Affairs: Blogs on CVS Caremark use of QALY Thresholds to Withhold Coverage
 
Last week, Health Affairs published two competing blogs about CVS Caremark’s decision to offer its employer clients a plan that would limit formularies to drugs under $100,000 per QALY.  Unfortunately, there was no perspective included from patients and people with disabilities, despite a recent letter to CVS Caremark opposing use of QALYs from over 90 advocacy organizations.  The National Pharmaceutical Council argued that “...CVS assumes that the field of value frameworks is fully mature, has addressed the many limitations of the QALY, and is ready for prime time, which it is not.”  CVS Caremark argued, "Quantitative methods, such as the concept of QALY, can help stakeholders compare the costs and effectiveness of medications.”  PIPC Chairman Tony Coelho expressed disappointment that perspectives of patients and people with disabilities were not solicited.  He responded to the blogs that, “Patients and people with disabilities are going to have to work harder to get a seat at the table.”  Click here to view the NPC blog. Click here to view the CVS Caremark blog. 
 
4. Mental Health America: 2019 Call for Proposals is Now Open
 
Mental Health America is now accepting workshop proposals for its 2019 Annual Conference Dueling Mental Health and Chronic Conditions in Children and Adults. “There is a lack of uniformity across the health spectrum in how illnesses are categorized and deemed as chronic diseases and chronic conditions. Not only does this create confusion, but it may lead professionals across the spectrum to focus on specific illnesses and disregard other aspects of the person being treated, including co-occurring issues like mental health conditions and broader societal conditions such as poverty, trauma, and racism. To effectively treat an individual, we must look at the whole person, which means examining the connections that exist between traditional chronic physical conditions and mental health concerns. At MHA’s Annual Conference, we will offer a traditional mixture of keynote speakers, plenary discussions and workshop panels.” Click here for details. 
 
5. Don’t Miss a Beat: The Latest on Heart Valve Disease Research and Policy
 
The Heart Valve Disease Policy Task Force will host a briefing on Capitol Hill to discuss heart valve disease research and policy. “Join us for an educational lunch briefing to learn about: the latest in heart valve disease research from leadership at the National Heart, Lung, and Blood Institute, the heart valve disease patient experience, the transcatheter aortic valve replacement (TAVR) National Coverage Determination from the Centers for Medicare and Medicaid Services, and how volume requirements impact smaller communities and rural hospitals.” Contact [email protected] to RSVP.
 
6. Beyond Opioids: Evidence-Based Delivery of Alternative Treatments for Chronic Pain
 
PCORI will host a briefing on Capitol Hill to discussed evidenced-based delivery of alternative treatments for chronic pain. “There is evidence to support the efficacy of alternative treatments for chronic pain—including cognitive behavioral, physical, and pharmacologic therapies—what we don’t know is how to implement these strategies in different populations with different care needs and goals. Chronic pain patients are individuals, each with a unique set of pain management needs. Comparative clinical information is needed to determine what works, for whom, and when. Congress is currently considering legislation—The Opioid Crisis Response Act of 2018—that includes provisions encouraging the use of non-addictive alternatives to opioids. It is crucial that Congress understand the value of research in building an evidence-base that can inform the wider use and implementation of safer chronic pain treatment modalities in real-world clinical settings.” Click here for details.  
 
7. Other Upcoming ICER Studies: Angiodema, Asthma, Opioid Use Disorder
 
The Institute for Clinical Economic Review (ICER) conducts cost effectiveness studies for insurers using the cost-per-QALY methodology. ICER provides guidance on its website for patients and patient advocates to provide direct input related to their experiences with the disease. Click here to provide patient input. Click here to view the topics and deadlines. Please note the following upcoming formal ICER deadlines per their website:
 
Prostate Cancer: Final Evidence Report 10/4/18
Amyloidosis: Final Report 10/4/18
Hereditary Angiodema: Public Meeting 10/25/18
Opioid Use Disorder: Draft Evidence Report 9/5/2018 with comment period through 10/4/2018
Asthma: Draft Voting Questions and Evidence Report 9/24/2018 with comments through 10/22/2018
Atherosclerotic Cardiovascular Disease: Draft Scoping Document 8/30/2018, comments open through 12/17/18
Spinal Muscular Atrophy: Revised Scoping Document Published 9/19/18
 
8. GHLF: A Patient’s Guide to Insurance Enrollment
 
The Global Healthy Living Foundation (GHLF) has launched “A Patient’s Guide to Insurance Enrollment,” for the chronic disease patient community and their families to consult prior to, and throughout, the upcoming 2019 open enrollment period. “Living with a chronic illness is tough, and dealing with health insurance doesn't make it any easier. That's why we've put together this guide on health insurance and Open Enrollment 2019. Learn how to get covered, how to tell if your medication is covered, and important things to watch out for.” Click here to view. 
 
9. Medical Xpress: Patient-Centered Visual Aid Helps Physicians Discuss Risks, Treatments With Parents
 
An article in Medical Xpress discusses how visual aids can help patients and physicians make informed, patient-centered decisions. “A series of illustrations and charts designed as decision aids for parents of children with minor head injuries helped them communicate with emergency medicine physicians and make informed decisions about their child's care, according to a study that will appear Sept. 21 in JAMA Network Open. The study, led by investigators at the Mayo Clinic, was conducted in seven medical centers, one of which was UC Davis Medical Center's emergency medicine department in Sacramento. It included 172 clinicians who cared for 971 children aged 2 to 18 who were evaluated for minor head trauma and were at intermediate risk for TBI. ‘Parents who used the decision aid had a better understanding of the symptoms of concussion, their child's relative risk of brain injury, and the pros and cons of cranial CT scans compared with active monitoring of signs and symptoms at home that would require a return visit to the emergency department,’ said Erik Hess, an emergency medicine physician and first author of the study who is now at the University of Alabama Medical Center in Birmingham.” Click here to read the article. 
 
10. 2018 Health Care Payment Learning and Action Network (LAN) Fall Summit
 
The 2018 Health Care Payment and Learning Action Network (LAN) will hold its fall summit on Monday, 0ctober 22, 2018, including a panel on patient engagement with PIPC Executive Director Sara van Geertruyden. The 2018 Summit will continue to build on the momentum of the LAN by bringing together stakeholders from across the health care system to transform payment in a way that emphasizes quality over volume. The Summit will feature leaders and innovators in health care as speakers in plenary and break-out sessions throughout the day, including the following: Industry leaders discussing an array of innovations in payment reform, touching on implementation methods and lessons learned; Federal and state health care purchasers describing how they are addressing the current and future health care delivery challenges via new payment models that put the patient first; and LAN Summit attendees collaborating in facilitated workshops designed for specific stakeholder groups focusing on vital areas of interest – and challenges — surrounding design and implementation of APMs. Click here to register. 
 
11. 2018 PCORI Annual Meeting
 
The 2018 PCORI Annual Meeting will take place on Wednesday, October 31, 2018 to Friday, November 2, 2018 in Washington, DC. “As part of this year's theme, ‘From Evidence to Impact: Putting What Works into Action,’ attendees will hear about results from PCORI’s comparative clinical effectiveness (CER) studies, efforts to promote essential findings, and those findings’ impacts. We will also discuss important trends in patient-centered outcomes research and connect with colleagues to share ideas for future research opportunities that will help patients and those who care for them make better-informed healthcare decisions. We are pleased to host two keynote speakers, Amy Berman, RN, Senior Program Officer, John A. Hartford Foundation, and Mark Smith, MD, founding president, California Health Care Foundation.” Click here for details.
 
12. Upcoming Events and Webinars 
   
PCORI Invoicing 101: Tips, Tricks and Reminders
September 27, 2018
Click here for details.
 
Training Course on Real-World Data
September 27-28, 2018
Click here for details.
 
Beyond Opioids: Evidence-Based Delivery of Alternative Treatments for Chronic Pain
October 2, 2018
Click here for details
 
Second Annual Duke-Margolis Conference on Real-World Data and Evidence
October 3, 2018
Click here for details.
 
3rd Annual Outcomes-Based Contracting Summit
October 3-4, 2018
Click here for details.
 
Cycle 3 2018 Improving Methods Applicant Town Hall
October 17, 2018
Click here for details.
 
eyeforpharma Value Summit 2018
November 7-8, 2018
Click here for details.
 
Advisory Panel on Clinical Effectiveness and Decision Science Fall 2018 Meeting
November 30, 2018
Click here for details.
 
2019 NEC Symposium
June 2 - 5, 2019,
Click here for details.
 
13. Medical Journal Articles
 
Key Issues and Potential Solutions for Understanding Healthcare Preference Heterogeneity Free from Patient-Level Scale Confounds, click here to view. 
 
Applying a Community-Based Participatory Research Framework to Patient and Family Engagement in the Development of Patient-Centered Outcomes Research and Practice, click here to view. 
 
The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity, click here to view. 
 
Lessons on Patient and Stakeholder Engagement Strategies for Pipeline to Proposal Awards, click here to view. 
 
"Precision Health" for High-Need, High-Cost Patients, click here to view. 
 
Industry Sponsorship and Research Outcome: Systematic Review with Meta-Analysis, click here to view. 
 
Picture This: Presenting Longitudinal Patient-Reported Outcome Research Study Results to Patients, click here to view. 
 
Patient-Reported Outcome Measures in the Food and Drug Administration Pilot Compendium: Meeting Today's Standards for Patient Engagement in Development, click here to view. 
 
A Qualitative Study of Patients' Perceptions of the Utility of Patient-Reported Outcome Measures of Symptoms in Primary Care Clinics, click here to view. 
 
Building Meaningful Patient Engagement in Research: Case Study From ADVANCE Clinical Data Research Network, click here to view. 
 
A Novel Stakeholder Engagement Approach for Patient-Centered Outcomes Research, click here to view. 
 
Multistakeholder Engagement in PCORnet, the National Patient-Centered Clinical Research Network, click here to view. 
 
Return of Research Results to Study Participants: Uncharted and Untested, click here to view.
 
14. AHRQ Effective Program Updates
 
Labor Dystocia, click here to view. 
 
Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update, click here to view. 
 
Randomized Trial of a Patient-Centered Decision Aid for Promoting Informed Decisions about Lung Cancer Screening: Implementation of a PCORI Study Protocol and Lessons Learned, click here to view. 
 
Collaboration Is Key to Accelerating Diagnostics Access to Optimize Benefits of Precision Medicines, click here to view. 
 
Registries for Evaluating Patient Outcomes: A User’s Guide Call for Case Examples, click here to view. 
 
Telehealth for Acute and Chronic Care Consultations, click here to view. 
 
Library of Patient-Centered Outcomes Research Resources, click here to view. 
 
Mobile Health Applications for Self-Management of Diabetes, click here to view. 
 
Role of Immunotherapy in the Treatment of Asthma, click here to view. 
 
Library of Common Data Definitions: Atrial Fibrillation, click here to view.
 
Library of Common Data Definitions: Asthma, click here to view. 
 
Patient or Participant Generated Registries, click here to view. 
 
Effects of Dietary Sodium and Potassium Intake on Chronic Disease Outcomes and Related Risk Factors, click here to view. 
 
Prioritization and Selection of Harms for Inclusion in Systematic Reviews, click here to view.

Comments are closed.

    Topics

    All
    Alternative Payment Models
    Chairman's Corner
    Patient Centered Research
    PIPC In The News
    PIPC Patient Blog
    PIPC Weekly Update
    Press Releases
    The Data Mine
    Value Frameworks

    Archives

    May 2025
    April 2025
    March 2025
    February 2025
    January 2025
    December 2024
    November 2024
    October 2024
    September 2024
    August 2024
    July 2024
    June 2024
    May 2024
    April 2024
    March 2024
    February 2024
    January 2024
    December 2023
    November 2023
    October 2023
    September 2023
    August 2023
    July 2023
    June 2023
    May 2023
    April 2023
    March 2023
    February 2023
    January 2023
    December 2022
    November 2022
    October 2022
    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013
    June 2013
    April 2013
    March 2013
    December 2012
    November 2012
    February 2012
    September 2011
    August 2011
    July 2011
    May 2011
    March 2011
    November 2010
    October 2010
    September 2010
    August 2010
    April 2010
    March 2010
    February 2010
    December 2009
    September 2009
    July 2009
    June 2009
    May 2009
    February 2009
    January 2009
    December 2008

Powered by Create your own unique website with customizable templates.