There is a growing concern that untested new treatments and drugs are driving up the cost of health care. Consumers and payers don’t have enough trusted sources to evaluate the value of costly, new interventions – whether they are worth what they charge. The Institute for Clinical and Economic Research (ICER), a leading and trusted source for that information, is updating the methods they use to develop value reports. ICER’s Value Assessment Framework is based on almost ten years of experience working with all stakeholders across the health care system. The framework involves a deep dive into the comparative clinical effectiveness and comparative value of interventions. Research is then thoroughly vetted publicly through committees of clinicians, researchers, patient and consumer advocates such as CEPAC which focuses on the health care needs of New England states. ICER works with all health care stakeholders to inform their independent assessments, which are increasingly helping payers, policymakers and consumers in maximizing the value of our scarce health care dollars. As part of their ongoing commitment to developing independent and useful assessments to enhance public dialogue about value, ICER is updating their methodology. As part of that update, ICER is soliciting comments and suggested improvements. Comments can be sent to firstname.lastname@example.org by September 12th. To help understand the framework and how it is used, ICER is hosting a webinar July 29th from 1 to 2pm. Register here.
Six of the 30 best performing local health systems are in the ERC region, according to the Commonwealth Fund’s 2016 Local Health System Scorecard – York PA, Providence RI, Lebanon NH, Boston MA, Worcester MA, and Rochester NY. Six ERC states — NH, CT, VT, MA, RI, and ME — were among the best nine in avoiding premature deaths preventable with better health care. None of the 30 lowest performing localities are in the ERC region. However health care costs more in ERC states than the rest of the nation, but there are important differences between Medicare and employer-sponsored coverage costs. There is wide variation between localities across the report’s 36 health care indicators of quality, access, avoidable hospital use, costs and outcomes. Generally low-income areas perform more poorly but the report includes important lessons that overcome that link. Investments in public health are making a difference including school-based care, social service collaborations, workforce training, data, and connecting people to coverage and medical homes. Overall the report found almost all localities in the US are making progress improving health but very slowly. New policies are making a difference including Affordable Care Act coverage expansions, Medicare’s hospital readmission and quality reporting initiatives, and FDA regulations and protections.
In a ruling released last week, Canada’s Federal Court upheld the constitutionality of the Canadian Patented Medicines Prices Review Board to ensure drug prices are not excessive. The Board uses scientific reviews of drug effectiveness along with economic and market analysis to define a fair price for each medication. Drug prices cannot be higher than the median in seven other countries including the US. Alexion Pharmaceuticals sued the PMPRB over the price decision for Soliris, a treatment for two rare, life-threatening diseases. Solaris costs as much as $585,000 for a single course of treatment; patient groups report that the price is keeping people in need from getting the drug. In addition to suing over the PMPRB decision, Alexion claimed that the agency’s price-setting work is unconstitutional. The Court ruled against the company on both counts. Alexion plans to appeal the decision to Canada’s Supreme Court.
Join us in Quebec August 7 – 10 for CSG-ERC’s Annual Meeting. The Health Policy Committee will explore policy options and tools to control rising drug costs.
Wednesday’s Medicaid Reform meeting hosted by CSG-ERC Health Policy Committee highlighted the variety of approaches states are taking to address their unique challenges. All states are committed to move away from volume-based payment models toward building value. All states were also committed, and have devoted significant resources, to quality improvement and delivery reform to build programs that are centered on patients. But states face different challenges, cultures and capacity. The all-day meeting at the Boston State House included Medicaid officials, legislators, staff, federal officials and other stakeholders. We heard from Bailit Health researchers about their recent survey of Medicaid reforms across the US. The survey found that states are moving into value-based purchasing because of strong pressure from CMS, internal strategic priorities, budget constraints, and active policymakers. State Medicaid programs are moving more slowly and tentatively into financial risk models than the private sector because of the unique nature of the program, its providers and members. We also heard from NESCSO, a non-profit organization funded by New England states to support state Health and Human Service Agencies. NESCSO provides staff training, information exchange, and collaborative solutions such as joint purchasing of services to support reform. NESCSO is planning to bring panels of federal health officials to states. To start the lively Policymakers’ Roundtable discussion we heard from Medicaid officials from NY, MA, RI, VT and CT. Discussion focused on what has worked and where the challenges still are. One member noted that “Medicaid reform is not like flipping a switch. It’s more like slowly turning up a dimmer.” We heard about new DSRIP opportunities, Accountable Care Organization development and regulation, underservice protections, multipayer collaboration, aligning quality targets, addressing social determinants of health, re-focusing programs on members’ needs, strengthening primary care and care coordination. The main request from participants to CSG-ERC for the future was to continue opportunities to meet and share resources.