Emerging value-based policies are no doubt well-intentioned efforts to achieve better outcomes at lower costs. However, missing from many initiatives seems to be clear recognition about whose value ought to be prioritized -- that of individual patients or society overall.
Medicare Part D beneficiaries can face as much as 33% coinsurance for some drugs listed in a “specialty tier,” which can result in thousands of dollars in out-of-pocket costs. The concern, of course, is that this level of cost-sharing creates a barrier that may put patients at risk for poor outcomes because they cannot afford the drugs they need. Jalpa Doshi and colleagues have looked at this issue in three studies of patients with very different conditions, and found that cost sharing was associated with reduced or delayed initiation of a drug, low adherence to a prescribed drug regimen, or interruptions in treatments. We’ve put this evidence together in a handy one-pager.
A new multidisciplinary consortium of more than 20 experts and stakeholders has come together at Penn to address the promise and challenges of precision cancer medicine. Through multiple conference calls culminating in a conference in May 2017, the group will tackle the hard questions that precision medicine raises for patients, providers, and payers. This is the first in a series of posts on the consortium’s work.
October 21, 2016 [cross-posted from the Health Cents blog on philly.com]
Along with improving quality, cost containment is vital to redesigning American health care to increase value. For policymakers and health care leaders, accurate “costing” of care is needed to shift towards a more value-based system that patients are able to navigate.
In early 2015, we received pilot funding from LDI to estimate the number of opioid pills left unused following a common outpatient surgery: tooth extraction. We enrolled 79 dental patients over six months. Our results showed that patients used an average of 46% (13/28) of the opioid-containing analgesic pills prescribed for them after surgery, and 1,010 pills remained unused among this group. If generalized to all patients, these results suggest that more than 100 million opioid analgesic pills remain unused following tooth extractions in the United States each year.
Dan Polsky was a bit skeptical when he heard the news that, after a 10-story fall and a week-long coma, construction worker Kal Mathyssen had awakened with the ability to fully understand his health insurance policy. So Polsky decided to give Kal the ultimate test: could he describe the breadth of the provider network in his insurance plan?
As I listened to Gerard Anderson, PhD at recent seminars at the Department of Anesthesiology and Critical Care and the Leonard Davis Institute, I reminisced about many hours sitting on the couch in his office at Johns Hopkins talking about my research career. One of the best pieces of advice he gave me was to always understand your audience.
Prisons and jails in this country are now serving as de facto mental health care institutions. We believe that this represents an ethical and social justice transgression and should be at the center of civic discourse—particularly during an election year. To bring this situation to light and elevate the conversation and debate, we are convening a diverse group of health care providers, law enforcement officials, mental health care advocates, academicians, and bioethicists in Philadelphia on Oct. 20 for “Recovering Inside: Ethical Challenges in Correctional Mental Health Care.”
While a tax on sugary drinks is grabbing the headlines in Philadelphia, several cities and states are exploring other interventions to curb the consumption of sugary drinks, and hopefully reap health benefits. One such proposal is to put warning labels on sugary drinks, or on the advertising for them, calling out adverse health effects, particularly obesity, diabetes and tooth decay. While we can’t yet evaluate the real-world impact of sugary drinks warning labels, recent work by Christina Roberto and colleagues tests the extent to which exposure to warning labels on beverages might influence beliefs and purchasing choices of adolescents and parents.
Richard "Buz" Cooper, MD, noted LDI researcher and health policy contrarian who died this year, played “hard ball” every day for decades, telling it like he saw it, making observations that made us pause, and questioning assumptions that did not jibe with his clinical experiences and common sense. Typical of his intensity and humor, he was known to say that if the association between the number of surgeons and the number of operations was due to surgeon-induced demand, what might obstetricians be up to that resulted in the birth of more babies in communities with more obstetricians? Eventually this line of thinking led him to wonder if the problem had little to do with the number of doctors and everything to do with the underlying demographics of communities, especially the uneven geographic distribution of the poor. Could their high illness burden, use of expensive healthcare, and poor outcomes be related to preexisting conditions and delayed access to healthcare?