Practice Transformation
Primary care is the key to transforming health care in America, write ACP President George M. Abraham, MD, MPH, and AAFP President Ada D. Stewart, MD. With that, they announced the launch of Primary Care for America, a collaboration focused on demonstrating the value of primary care. “Unfortunately, the US health care system has long over-emphasized and over-invested in the sub-specialization of physicians and the specialization of care.” The result: a health care system that overspends and underperforms and a population that is less healthy.” (Politico)
Evidence & Innovation
Nearly $50 billion of Medicare Part D costs in 2016 were for drugs that did not undergo a cost-effectiveness analysis. That comes to about a third of Part D spending, according to research published in JAMA Network Open. “In addition, the quality of cost-effectiveness evidence was often inadequate. Improving the value of spending on prescription drugs may be considered an element of US health policy reforms in the future, and efforts for value-based reforms may be hampered by a lack of cost-effectiveness data,” researchers concluded. (JAMA Network Open; Becker’s Hospital Review)
Five Blue Cross Blue Shield plans have launched Evio, a new for-profit pharmacy solutions company, to combat drug costs. Evio will use member data to collect real-world evidence into how drugs actually perform, especially across specific patient types and with certain comorbidities. Among the goals: Get drugmakers to agree to outcomes-based contracts, where the plans pay in accordance with drugs’ effectiveness. “We can find ways—if we’re creative and all sides are willing to partner—to tie incentives to those drugs,” says Hank Schlissberg, Evio’s CEO. (Modern Healthcare*)
The shift away from centralized mass vaccination centers illustrates how the push for vaccines is moving to a targeted “ground game,” The New York Times reports, likening the new approach to get-out-the-vote efforts. Among the high-profile examples: Dr. Anthony S. Fauci and Washington DC Mayor Muriel E. Bowser went door-to-door in the city’s Anacostia neighborhood encouraging residents to get vaccinated. Even they were turned down by some unvaccinated residents. New Jersey has deployed 2,000 canvassers to areas with low vaccination rates. (New York Times; GTMRx blog)
Only 39% of respondents to a recent survey said their practices had taken concrete steps to address burnout in the prior 12 months. Of particular concern: Those who said their practice hadn’t taken such steps are much more likely to report feeling rushed in their interactions with patients. Among the other findings: More female physicians (32%) reported feeling burned out at least once a week compared to male physicians (26%). Older physicians (65+) were burned out less frequently (with 52% responding “never” or “a few times a year or less”) than those under 65 (37%). (HealthLeaders Media; athenahealth announcement)
Policy Solutions
Ariadne Labs and Boston Children’s Hospital, with support from Google, launched the Vaccine Equity Planner, a data-driven tool to help U.S. state and local planners find “vaccine deserts” —areas with limited access to COVID-19 vaccines. It helps public health leaders plan for how to equitably deliver the vaccine to the remaining U.S. population lacking access. It also identifies potential future vaccination sites, such as primary care practices, pharmacies, schools, places of worship and other potential vaccination venues within the deserts. (BioSpace; Vaccine Equity Planner)
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In Case You Missed It!
Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
- Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
- Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
- Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
- Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
- Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
This roundtable focused on payment, policy and practice reform to support optimized medication use. The event was moderated by Susan Dentzer, Senior Policy Fellow, Robert J. Margolis Center for Health Policy at Duke University with welcome and introductions by GTMRx President Paul Grundy, MD, Chief Innovation Officer, Innovaccer. The rest of the agenda includes:
- Value Based Payment: Current Landscape
- Introduction by Brian Litten, J.D., Chief Strategic Growth Officer, Tabula Rasa HealthCare; GTMRx Pharmacogenomics Payment and Policy Taskforce Co-lead
- Andrew MacPherson, Managing Partner, Healthsperien, LLC
- Measures to Motivate Adoption
- Introduction by Kathy Pham, PharmD, BCPPS, Policy and Professional Affairs Director, American College of Clinical Pharmacy (ACCP); GTMRx Payment and Policy Solutions Workgroup Co-lead
- Curtis Haas, PharmD, FCCP, Chief Pharmacy Officer, University of Rochester Medical Center in New York
- Value Based Payment: CMS
- Introduction by Tom Kraus, J.D., MHS, VP Government Relations, American Society of Health-System Pharmacists (ASHP); GTMRx Pharmacogenomics Payment and Policy Taskforce Co-lead
- Amy Bassano, Deputy Director of the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid
- Reactor Panel discussion
- Matt Salo, Executive Director, National Association of Medicaid Directors (NAMD)
- Allan Goroll, MD, Professor of Medicine, Harvard Medical School, Massachusetts General Hospital
More information can be found here.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
- Accelerated approval of vaccines
- Public education
- Payment reform
- Improved vaccine access for primary care practices
- More effective immunization information systems (IIS)
- No cost-sharing for certain patients
- Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
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