GTMRx News Brief Archive

Practice Transformation Analysis: Hospitals dramatically marking up prices Hospitals mark up prices on medicines by an average of 250%—and some as much as 533%, according to Bernstein analyst Ronny Gal. For example, Neulesta, a drug given to chemotherapy patients, was marked up 364% percent on average. Hospitals also charge different prices for the same drug: The average variation is about 36%. To use the Neulesta example again, some hospitals charge $5,000 per treatment, while others charge $20,000. Such markups incentivize…

Practice Transformation Commentary: The case against prior authorization In an opinion piece for STAT News, Brian Barnett, MD, of the Cleveland Clinic and Case Western Reserve University School of Medicine, makes a case against prior authorization. It puts patients in the crossfire between pharmaceutical companies, PBMs and insurers, he argues. “Being regularly compelled by insurers to reconsider and justify treatment decisions we have made in our patients’ best interests, providers are increasingly wondering who’s actually doing the prescribing — us…

Practice Transformation Trend: Blurred lines between payer, provider Expect the continued rise of “payviders” this year. These are insurers that have bought or partnered with medical groups and other providers. “The line between providers and payers is getting blurrier and blurrier over the course of time with major payers taking significant positions in the provider space,” David Morlock, a managing director in Cain Brothers’ Health Systems M&A group, tells Modern Healthcare. Such arrangements typically involve global budgets—that means keeping patients out…

Practice Transformation Wholesale drug price hikes affect payers, patients Drug wholesale list price increases in 2010-2016 led to a rise in payer spending and out-of-pocket costs for patients, according to a study published in JAMA Network Open. Adjusting for inflation, median patient out-of-pocket costs for specialty medications rose by 85%; non-specialty medications rose by 42%. “This finding suggests that, although discounts and rebates significantly reduce the amount paid for drugs and have increased over the past several years, they have not…

Practice Transformation Understanding pharmacy specialization Specialization in any health profession is primarily a function of the reality of ever?increasing scientific and technological developments. Debate regarding the need, types and value of specialization in pharmacy seem destined to be driven not by intra? or inter?professional debates within pharmacy, but by the needs, expectations and values of patients and health care systems. This podcast episode provides an opportunity to learn about pharmacy specialization from, among others, Edwin Webb, PharmD, MPH, FCCP, Brian L.…

Practice Transformation Consumer awareness changes precision medicine landscape Consumers have become aware of specific precision medicine therapies can help treat the diseases they or their loved ones have, and this growing awareness is changing the precision medicine arena, according to experts on a recent MedCity INVEST Precision Medicine panel. But cost is a big factor: Consumers have a “walk away” price—and it’s much lower than most people think it is, according to Julie Grant, general partner at early-stage venture capital…

Practice Transformation Will lack of interoperability affect vaccine distribution? The COVID-19 vaccines will arrive before interoperability will. That may not be a surprise, but it is a concern. It means the digital connectivity needed to closely track doses, side effects and continuing infections is still lagging behind, STAT reports. The U.S. Digital Service recently reported that site visits to public health agencies revealed a heavy reliance on paper documents and fax machines to collect and share data on COVID-19 tests. (STAT) Primary…

Practice Transformation Adopt biosimilars to improve access, cut costs Adopting biosimilars in clinical care can improve access and reduce costs without impairing patient care, argues a paper published last month in Pharmacy Times. Price reductions of 20% to 30% appear typical; this can improve patient access to treatment. The authors outline strategies for moving forward and identify key considerations, including patient and physician buy-in. "By addressing the use of biosimilars in a systematic, rational manner and putting appropriate safeguards in place, institutions…

Practice Transformation For ROI, identify docs willing to change Where care is delivered heavily influences both the price and the price variations. The potential for savings is tremendous, but that potential hasn’t been fulfilled. One reason is the challenge of getting physicians to alter their referral practices. The Clinician Behavior Change Model addresses that challenge. A recent Harvard Business Review article looks at the model in the context of selecting lab testing sites. Among the lessons: “By identifying clinicians who are more and…

Practice Transformation Antibiotics for babies? Don’t mess with the biome Children under age 2 who take antibiotics appear to be at increased risk for childhood-onset asthma, respiratory allergies, eczema, celiac disease, obesity and ADHD, according to research published in Mayo Clinic Proceedings. As with so much, it comes down to the microbiome. “Overall, our findings extend the associations between early antibiotic exposure and later development of asthma, allergic diseases, and autoimmune conditions described previously. We hypothesize that antibiotics play a causal role…

Practice Transformation Team-based care, with clear roles, improves patient engagement Practices with a team-based care infrastructure are better at patient engagement initiatives than those without, according to research published in the Annals of Family Medicine. “Collectively, our findings suggest that strengthening the foundation of the medical home by promoting full staffing of primary care teams, clearly defined roles of team members, effective leadership, and a practice culture of performance improvement may increase adoption and use of patient engagement practices,” the…

Practice Transformation About a third of minors take supplements Approximately one-third (34%) of U.S. children and adolescents take dietary supplements, according to research published in the Oct. 30 issue of the CDC’s Morbidity and Mortality Weekly Report. The most frequently used products were multivitamin-mineral products, which were used by 23.8% of children and adolescents. The researchers note that supplement use might mitigate nutrient shortfalls, but it may lead to intake above recommended upper limits for some nutrients. They also point out…

Practice Transformation Study: Medication events most common safety issue in ambulatory care Data from a multistate patient safety organization database reveals that medication-related events are the most common patient safety incidents in ambulatory care settings. The findings were published in The Joint Commission Journal on Quality and Patient Safety. Across all categories, the 2,701 events were associated with 51 deaths, 159 severe harm events, 1,180 moderate harm and 926 mild harm. Medication-related events accounted for 45.3% of all errors. “These results can…

Practice Transformation Vaccine allocation framework: Start with health workers, first responders The National Academies of Sciences, Engineering, and Medicine has released Framework for Equitable Allocation of COVID-19 Vaccine, a consensus report recommending equitable allocation framework for COVID-19 vaccine allocation. It recommends using existing systems across all levels of government to ensure equitable allocation, distribution and administration of COVID-19 vaccine; launching a COVID-19 vaccine promotion campaign and risk communication and engagement program; and supporting equitable allocation globally. The framework would begin vaccinations…

Practice Transformation Nash on “payviders” and other trends to watch What’s next? David Nash, MD, MBA, recently identified several trends to watch, reports MedPage Today. One is personalized medicine. Soon, it will be possible to take a “buccal smear, get your genetic makeup, and make a prediction about your own health, even in the primary care doctor's office.” A related trend: the convergence of artificial intelligence, predictive analytics, machine learning and population health intelligence. Then, there’s the rise of the "payvider.” "We're…

Practice Transformation Strong, defined care teams improve patient engagement Patient engagement programs need a strong team-based care infrastructure, according to research published in the Annals of Family Medicine. Researchers drew from the VA Patient-Aligned Care Team (PACT) 2016 national survey of direct care clinicians. Among the findings: “Working in a chaotic clinic environment with vague team boundaries is associated with higher barriers to providing patient-centered care. Clear expectations of each team member’s duties and responsibilities are needed to optimize the team’s…

Practice Transformation Viewpoint: A call for algorithmic stewardship Algorithms are not new in health care, but newer emerging algorithms are increasingly complex and require oversight and quality control, according to the authors of “The Case for Algorithmic Stewardship for Artificial Intelligence and Machine Learning Technologies.” When used appropriately algorithms can improve the diagnosis and management of disease, but they also have the potential to “exacerbate existing systems of structural inequality." They identify several key considerations for emerging algorithmic stewardship programs.…

Practice Transformation COVID-19 vaccine: What messaging works? Unlike with other vaccines, talking about the public good won’t convince patients to get the COVID-19 vaccine. Civis Analytics tested five messages with 4,000 respondents. Personal stories proved to be the best motivator. When a respondent hears about a real person who contracted COVID-19 and died, they were 5% more likely than the control group to agree to the vaccine. However, when the message was about making communities healthier for everyone, they were…