Real Endpoints will be on holiday until January 2, 2012. Wishing you and yours the very best this holiday season. Peace and joy in the New Year. Thanks for reading!
ICD-10: A Gift for Product Makers
There’s been a lot of talk about the migration from ICD-9 to ICD-10 and what’s going to happen in October 2013 when we jump from a medical coding system with around 18,000 codes to one with around 8 times that number. In theory, the more precise mechanism to account for diagnoses and procedures provided by the federally mandated 10th revision of the International Classification of Diseases should improve cost management, budgeting, and outcomes research while … Continue reading
Our Two-Tiered Healthcare System
Bundled payments are coming! Bundled payments are coming! With the announcement Dec. 19 of the creation of pioneer accountable care organizations, fee-for-service’s swan song has begun. Or maybe not. The ability to move away from FFS to a bundled reimbursement environment is predicated on providers’ readiness. But readiness is more than the obvious informational and data challenges (figuring out actual costs, for example). It’s also about the ability to handle two basic payment systems – … Continue reading
Moving to ACOs: It's Complicated
Oh Pioneers! Health and Human Services released its much ballyhooed list of the organizations participating in its Pioneer ACO initiative on December 19th. What’s striking isn’t who’s on the list, but who’s not. No Mayo Clinic, no Cleveland Clinic, no Geisinger Health Systems, no Kaiser Health Network. Indeed, of the 32 founding organizations, most aren’t exactly what you would call household names: Partners Healthcare and Beth Israel Deaconess are the two recognizable exceptions. Recall that … Continue reading
The Healthcare Round-Up: 12/12 -12/19
Here at Real Endpoints, we know you’re busy. And we’re aware that trawling the web for reimbursement-focused news can be a time-consuming slog. That’s why we’re introducing “The Healthcare Round-up”, a one-stop resource for the best reimbursement-related analysis and news coverage appearing on the web in the past seven days. See a story that’s interesting? Send it our way for potential inclusion. And make sure to tell us what you like — and what you … Continue reading
Biosimilars: Proving Pharma Gets Cost-Driven Innovation
We called in a previous post for a new definition of healthcare innovation – specifically, one that includes value. One need look no further than branded pharmas’ (and biotechs’) growing love affair with biosimilars for proof that at least some companies understand – or at least claim — that innovation is about more than novel targets and mechanisms of action. “Shot through with innovation,” is how Merck BioVentures’ president Mike Kamarck describes the biosimilar enterprise. Kamarck, … Continue reading
Payer-Pharma Data Collaborations: Anything More Than Business as Usual?
2011 was a break-out year for deals between pharmaceutical companies and payers, with three major drug makers – AstraZeneca, Sanofi, and Pfizer – inking broad alliances with the research/data businesses or departments of WellPoint, Medco Health Services, and Humana. Theoretically, all three deals are attempts to orient pharma R&D programs closer to results that matter to payers. Explaining AZ’s rationale for its deal with WellPoint’s HealthCore unit to the audience at Elsevier Business Intelligence’s annual Pharmaceutical … Continue reading
Set The Price Up Front: Iressa Single Patient Access Scheme Shows How Risk-Sharing Can Work
AstraZeneca may have figured out how to make risk-sharing work in the U.K. – and even beyond. My last post highlighted how some programs, like J&J’s Velcade Response Scheme, are too complex and costly to administer, and thus don’t work – at least not for the payer. AstraZeneca’s Single Payment Access (SPA) scheme for lung cancer drug Iressa, recommended as part of cost-watchdog NICE’s nod to the drug’s reimbursement in May 2010 isn’t simple. National Health … Continue reading
Payers Diversifying for Pharma Dollars, Among Others
Among payers, uncertainty – mostly around the impact of the Affordable Care Act — has bred diversification. And much of that diversification has involved information businesses. Humana’s acquisition of San Diego-based Anvita Health is just the latest example of a payer looking for new revenue sources. This year alone, Aetna, for instance, has purchased Continental Life Insurance and PayFlex Holdings, deals that bolster the insurer’s footprint in the Medicare Supplement and consumer products businesses, while … Continue reading
Putting A Price On Eylea: Why Regeneron's Decision Matters
Kudos to the commercial team at Regeneron for understanding that reimbursement is an environment. That is: Regeneron doesn’t think that payers are the only ones who matter in the reimbursement decision. Just before Thanksgiving, the company took the unusual step of announcing it would price its newly approved wet AMD treatment Eylea at a discount to the standard-of-care Lucentis. “We feel the price is fair to physicians; it is also fair to Medicare,” SVP of … Continue reading