It’s certainly the biggest change in healthcare in my business lifetime: the transformation from a fee-for-service economy fueled by abundant dollars to an essentially capitated world of financial tradeoffs. The transformation will likely take longer than we expect. (What transformation doesn’t?) Still, payers and providers –and the various big and small service providers hoping to serve them — are already trying to improve swaths business processes as diverse as connectivity, transparency, and consumer communication (see … Continue reading
Reimbursement “Furies” Real, But Won’t Avenge Pharma Til 2017, Says Citi
“Beware the Three Furies,” warns Citi analyst Andrew Baum. In a report for pharma investors published Nov. 29., Baum turns to classical mythology to describe shared savings models, drug pathways and ACOs — the forces that will soon dominate US health care plans. He’s chosen an interesting analogy: The Three Furies were goddesses of vengeance, who punished the wicked for their crimes; they’re also described as “tormenting those who have yet to atone for their sins”. … Continue reading
The Value Debate: Can Personalized Drugs Support Personalized Pricing?
“Personalized health care requires a new reimbursement model,” declared Roche’s VP Global Pricing & Market Access Jens Grueger in the elegant London county hall debating chamber on Monday, at the Office of Health Economics (OHE)-sponsored gathering of payers, pharma and economists. The venue was appropriate. Debate centered around whether the move towards more personalized medicine could reasonably support more personalized pricing. Roche, with plenty of targeted medicines at stake, thinks, perhaps wishfully, that more differential, ‘value-based’ pricing is … Continue reading
Payers, Churn & What It Means for Total Cost of Care
One question we get from pharmaceutical and diagnostic clients quite frequently: do payers really care about lowering the costs of care if the cost savings don’t show up for a few years? The problem they’re talking about is churn: a payer invests in a new cost-saving therapeutic program … only to see the savings redound to his payer-competitor when the patient switches plans (which they do every 3-5 years). Take adherence. It should be an … Continue reading
The Healthcare Round-Up: August 3 -19
The Olympics (and shark week) are over, the dog days have officially arrived, and here at the West Coast branch of Real Endpoints, it’s back to work as the little people head back to school. (Already!) Given Mitt Romney’s choice of Paul Ryan as his running mate, it’s a sure bet healthcare (especially Medicaid and Medicare) will remain a subject of debate in the run-up to the presidential election. So will the subject of “big … Continue reading
Could German Pricing Reform Lead to More US-Style Payer Competition?
It’s an odd, chalk-and-cheese notion: that a typically European, rather socialist form of pricing and reimbursement reform such as AMNOG, Germany’s system of early added-benefit assessment for new drugs, could help drive more free-market-style competition between the country’s statutory health insurance (SHI) funds. There are signs that it’s happening, though — albeit via a roundabout route. That matters to pharma, since more competition among payers means a more aggressive efficacy drive. That may in turn … Continue reading
The Healthcare Round-Up: 4/14 – 4/21
The next big data visualization graphic: This week Express Scripts published its annual drug report. The big news: the cost of nonadherence. Indeed, $317 billion of the $408 billion in pharmacy-related waste accumulated in 2011 was due to failed medical adherence, more money than the combined drug costs associated with treating diabetes, congestive heart failure and cancer – combined. Working towards solutions for nonadherence obviously frees up a lot of resources that might be devoted … Continue reading
The Healthcare Round-Up: 3/28 – 4/4
Reducing unnecessary care: On Wednesday April 4, nine physician societies, together with the ABIM Foundation and Consumer Reports, released a list of 45 procedures or tests (5 per specialty) that are overused and adding to soaring healthcare costs as part of a new educational initiative called Choosing Widely. Another 8 specialty boards are preparing lists of relevant tests their members should be more judicious about ordering. Once again it’s a reminder that there’s growing support … Continue reading