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Our e-News Brief features the policies, people and research driving adoption of comprehensive medication management. Each week, you’ll receive the latest news about practice transformation, policy solutions, evidence and innovation that advance comprehensive medication management. Subscribe today, so you’ll never miss an issue.

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GTMRx News Brief

November 12, 2019

Practice Transformation

A recent Harvard Business Review article explored how new platforms will enhance patient care. Lyft and Best Buy’s Geek Squad are among the strange bedfellows delivering care to patients—or delivering patients to care. And, of course, there’s the dramatic upsurge in apps, virtual consults and all the other aspects of telemedicine. “What these trends point to is a dramatic expansion over the coming years of healthcare’s ‘front door’ as the focus of care shifts from the hospital or clinic to patients themselves—at work, home, or wherever their smartphones take them.” (Harvard Business Review)

Evidence & Innovation

A new cystic fibrosis therapy dramatically improved patients’ lung function and appeared to target the genetic root of the disease—“a breakthrough so long-sought that many doctors and patients are moved to tears when talking about it,” The Washington Post reports. The findings, announced at a conference and published in the NEJM and The Lancet, convinced the FDA to approve the three-drug therapy ahead of schedule. The therapy could benefit 90% of CF patients; previous drugs worked in only a few patients or had less potent effects. (Washington PostNEJM)
The last five years have brought meaningful changes in preapproval access to experimental drugs. As awareness and use increases, the line is blurring between it and the historical standard: controlled, randomized clinical trials. A Health Affairs Blog piece raised several ethical and practical questions. Over the next five years, patients, regulators, pharma, medtech companies, lawmakers and payers will be grappling with answers to these questions. “This evolution has the potential to fundamentally change the way in which new medicines are developed, and the timing of their being made available to patients. Payers will face tough choices about covering increasingly costly genetic and orphan interventions with less evidence.” (Health Affairs Blog)

Policy Solutions

The CMS will move forward with site-neutral payments for doctor’s visits, despite a federal judge’s ruling against the policy. The Outpatient Prospective Payment System will pay doctors the same for a basic visit whether it occurs in a hospital outpatient facility or a regular doctor’s office. The CMS estimates the change will cut copays for Medicare beneficiaries and cut federal spending by $800 million in 2020. The rationale: Outpatient clinics are more expensive than physicians’ offices, and shifting visits to a lower-cost setting could save money. Hospitals are not pleased. (Modern Healthcare)
CMS recently issued a proposed rule implementing electronic prior authorization for medications prescribed through Medicare Part D. It aims to improve patient access to medications and reduce provider burden. Manual prior authorizations have been a particular issue for medication requests under Part D plans. The rule would take effect January 2021. (RevCycle Intelligenceproposed rule)

Recording Available | Interoperability Forecast: Opportunities & Solutions for Comprehensive Medication Management

Earlier this year, The Centers for Medicare and Medicaid Services and the Office of the National Coordinator released their proposed new regulations to advance interoperability across the health care system and to make it easier for patients and caregivers to access their personal health information. The proposed regulations would have significant implications for how health plans, providers and others handling patient data format, exchange and use health care data. In addition to government-led initiatives, market players are moving forward with their own data and technology transformation strategies, alliances and product development efforts.

This webinar provides a view of developments in healthIT through the lens of our ability to provide a single view of patient care that is necessary to enable a person-centered approach to medication use to ensure appropriate use of medications and gene therapies.

Featuring the voices of Deb Gage, president and CEO at Medecision and GTMRx Institute board member, Lisa Bari, former health IT and interoperability lead at the Centers for Medicare and Medicaid Services’ (CMS) Innovation Center and Ryan Howells, principal at Leavitt Partners and lead at the CARIN Alliance.

Watch the recording.

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