Practice Transformation
Millenson: Enough with the secret analytics
Medicare Advantage plans secretly analyze members’ detailed information ranging from their credit scores and shopping habits to how they vote, writes Michael Millenson, president of Health Quality Advisors. “The use of what’s obliquely termed consumer data is increasingly common not only by health plans but also by health systems and others who have an economic interest in controlling costs.” It needs to stop: “Let me be clear: Secret analysis of information about individuals’ private lives in a health care context, even with the best of intentions, violates patients’ and plan members’ trust. No matter the motivation, it’s unethical.” He calls on Congress and regulators to act. (STAT News)
Axios: Employers kept in the dark about drug prices
Secretive contracts keep employers from understanding whether they are paying reasonable drug prices, according to an Axios investigation. Employers hire PBMs, which negotiate prices with drug manufacturers. Big consulting firms work with PBMs to organize drug pricing coalitions, pulling large employers into purchasing agreements that, in theory, maximize negotiating power. “But it can be difficult for employers to determine the financial upside of these arrangements,” reports Axios.” One coalition—named in the article—places” tight limits on employers’ ability to access information about their drug costs — and on their ability to analyze that data, if they can get it.” (Axios)
Goozner: Self-interest, silos make interoperability unlikely
Interoperability won’t arrive anytime soon, predicts Merrill Goozner. Health care in America takes place in silos, and with few exceptions, those fragmented organizations still refuse to communicate with each other. Moreover, promoting a national system for data exchange and interoperability is not a federal priority. “What prevented implementation of the law calling for health information interoperability? The short answer is the self-interest of every sub-industry within health care.” This has left him skeptical about the likelihood of interoperability anytime soon. “The government remains in their thrall.” (GoozNews blog)
Evidence & Innovation
Telehealth: 6300% growth between 2019 and 2020
Telehealth saw 63-fold increase between 2019 and 2020, growing from just 840,000 visits in 2019 to 52.7 million in 2020, according to a new HHS. Mental health has emerged as a key clinical area for telehealth due not only to the pandemic, but also the lack of available providers. However, Healthcare Dive notes that it remains unclear how many COVID-era flexibilities will continue after the national health emergency expires. How much payers will decide to reimburse for the service and how much patient demand will remain once fears of in-office virus transmission are less acute? (Healthcare Dive; HHS report)
Policy Solutions
Will psilocybin relieve clinician burnout?
What may be the first US study to examine a psychedelic’s effects on the mental health of health care workers is moving forward, Medpage Today reports. Anthony Back, MD, of the University of Washington is leading a randomized trial into how psilocybin combined with psychotherapy might help frontline health care workers handle pandemic-induced distress. “The current situation for healthcare workers is pretty serious, and it’s not clear that we have a documented therapy that really works,” Black said in a prepared statement. “So I think it’s important for us to be evaluating and assessing new treatments.” (Medpage Today*)
Kansas settles with PBM
Kansas will receive nearly $27.6 million from a legal settlement with Centene, which manages prescription costs for its Medicaid program. The settlement follows a nearly two-year investigation. Several states have been investigating PBMs, and Mississippi and Ohio in June settled lawsuits against Centene for a total of nearly $144 million. Prescriptions cost the Kansas Medicaid program more than $100 million per year after rebates from drug companies, according to the Kaiser Family Foundation. Attorney General Derek Schmidt’s investigation covered Centene’s actions since the start of 2016. (AP)
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In Case You Missed It!
SEE THE EVIDENCE | The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs
Learn about the peer-reviewed evidence showcasing the value of CMM, through improvements in access to care, provider work life, outcomes and patient satisfaction as well as a reduction in costs. These findings, updated in December 2021, outline the CMM team-based care process that can be implemented in a variety of health care systems to ensure positive patient outcomes.
SEE THE GUIDANCE | The Integration of Telehealth Delivery within a Comprehensive Medication Management Practice
Considering the advantages of telehealth and the future direction of health care, it is no longer a question of if telehealth needs to be implemented into practice; rather, it is a question of how to integrate telehealth and CMM services. Core to a plan is a patient care team that works together to achieve a goal of enhancing patient-centered care and medication optimization. Outlined are essential steps to integrating telehealth services and CMM practice: define what telehealth means for your practice, secure stakeholders, develop a team, equipment and software needs; assess costs and financial stability, educate staff, patients and caregivers, develop a workflow, measure health care outcomes and meet with your team regularly.
SEE THE GUIDANCE | Value Framework for Providing CMM in Telehealth
The escalation of telehealth has shed light on the opportunities that exist to increase patient access to care through virtual visits that extend beyond the traditional in-office visit. Included as an opportunity for telehealth is comprehensive medication management (CMM). This value framework, intended for health care team members, payers for health care services and health care policy makers, proposes a guide for providing CMM services via telehealth. Although obstacles to telehealth delivery of CMM exist, the benefits to providers, patients and payers outweigh the barriers. For sustainability of telehealth and CMM provided via telehealth, effort from multiple stakeholders is needed to address the challenges that exist.
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Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
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