What Is the Value of a Cancer Cure: Solvadi for Hepatitis C?

Direct patient health care costs of HCV

Detailing the business proposition and value-based decision points Specialty drug spending is expected to rise by 63% by 2016. Solvadi and some of the other new drugs present a pathway to the holy grail of US health care: a cure for cancer. Can we pay the costs that Solvadi and others coming in the pipeline will bring?  On the other hand, perhaps we should negotiate a price and give the drug to everyone with hepatitis C so we can end this problem.  Or maybe we need to fall somewhere in between. Questions of price, quality and value of pharmaceuticals will … More

Getting to Health Value with Social Determinants of Health

by Leonard Kish and Cyndy NayerTuesday, May 27, 2014 Published on ihealthbeat.org We hear a lot about the economic drain of health care, but what we may be seeing is the actual confirmation of the economic power in providing health care. In economic terms, there’s a very high opportunity cost to sickness and death. Preventing them can return dividends for society in real economic terms. We learned more about how access to health insurance and health care can benefit well-being as a whole with a recent Annals of Internal Medicine study of the Massachusetts health care system — the system on which the … More

Let’s Bring HopeBowl to Kids with Cancer

a project to improve lives This just in from daughter Melanie: I’m working on a social campaign with Red Sox pitcher Clay Buchholz and the Clay Buchholz Foundation called HopeBowl (#HopeBowl). The foundation supports children in need, mostly who are battling cancer and those with developmental issues who need extra support and care. The annual event to raise money for these important charities takes place on July 31. We created the campaign #HopeBowl as a way to encourage people from around the world to send in their messages and photos of support and encouragement to these amazing kids. Here’s how … More

Subsidies: On or Off or…

confusion picture from cyndynayer shows health care site misdirections

Courts of Appeals release conflicting rulings on ACA subsidies Subsidies are the foundation of the expansion of insurance to non-insured families under the ACA.  Today, two Courts of Appeals–one in DC, one in neighboring Virginia–released opposing rulings.  DC ruled that subsidies offered in states that did not have a state-run exchange were not valid.  Virginia ruled that subsidies offered in Federally Facilitated Exchanges are a reasonable accommodation of the law. The New York Times overview says this: The United States Court of Appeals for the Fourth Circuit, in Richmond, upheld the subsidies, saying that a rule issued by the Internal … More

HIX: Health Insurance Marketplace Thought Leaders

Health Insurance Marketplace Newsletter

July Thought Leaders Answer Questions on Success A columnist recently wrote that ‘the most fundamental problem’ with Exchanges is ‘they depend on people being highly knowledgeable health insurance shoppers, and that is never going to happen.’ Is that the case? Why or why not?”  Cyndy Nayer: “Exchanges do not demand that consumers be insurance intellectuals in order to succeed, any more than being car-intellectual is needed in order to purchase or lease a car. What is needed for an informed decision is a short series of questions that ‘profile’ the priorities and needs of the customer. Perhaps the most important … More

Marketplace: 57% of new enrollees were uninsured before

ACA and Obamacare

MCOL digests the KFF data Kaiser Family Foundation–KFF– issued a new summary on the enrollees in the insurance marketplaces, which MCOL has summarized.  In short, most of the enrollees in the #ACA were uninsured before the rollout, and most of the 57% had been without coverage for 2 years. The chronicles of the value-based movement have shown that when costs for acquisition (copays and co-insurance, often called out-of-pocket costs) are reduced, more people become engaged and adherent in their health care.  This is important in the management of chronic disease. But if we are determined to build a culture of … More

Accountability and Outcomes: Not Without the Consumer

confusion picture from cyndynayer shows health care site misdirections

value-based care is the desired approach, but the system is built to avoid it A recent editorial says that outcomes are derailed when fee-for-service is the foundation for success, as it is in our current care systems.  With the focus on population health, the goal is to get better outcomes, so it makes sense to pay for outcomes.  But in a fee-for-service system, the payment  is linked to quantity of services, which in turn drives more tests, images, inpatient, outpatient days, and so forth. The op-ed specifically states, “Those differing approaches to providing healthcare—actually, only value-based care can truly be called … More

What’s the Value of a Cancer Cure?

value-based Rx

Cyndy Nayer and Leonard Kish explore the value-based decisions in this longer version When CMS approved Solvadi, Gilead’s $84,000 drug for hepatitis C, the stakes were raised in drug price wars.  Two opposing forces, one, a financial push toward lower costs came up against an opposing force of public sentiment. The FDA’s goal of getting 90% of patients moved from costly branded prescriptions to generics met with an an large outcry in social and traditional media for providing the best available care, rallying around the story of a patient.   The wave of sentiment seems to have won over CMS. Granted, CMS … More

The customer: from dependent variable to independent co-creating agent

customer as co-creator with health system

comments on a provocative post in LinkedIn on shared creation Maarten Pieters, CEO at The CoCreators, writes an impressive blog post on engagement and the need to reorganize so that the customer becomes a co-creating agent.   Let’s discuss, first, what a co-creator is.  On their website, The CoCreators work from the premise that value must be created by and for the customer.  “TRUE VALUE IS ONLY CREATED BY INVOLVING THOSE YOU ARE CREATING FOR” is one of the key tenets of co-creation.  Hence, to be successful in acquiring customers, organizations must use every  modality, including social media, to attract people to the business … More

Goldman’s Exec: Economy Is Growing

according to cyndynayer, value-based designs can optimize affordable care and adherence

Nayer: it’s time to focus on fixing the income and housing risks to health Goldman’s top economist, Jan Hatzius, believes that the US economy is now growing at an above-trend pace.  This is great news regarding sustainability and income security.  For most. But Hatzius calls out the high student debt and overall slow pace of job creation as a hindrance to the recovery and expansion of the marketplace.   And there is still the issue of those without health care coverage or those with income insecurity–making less than the cost of living, managing multiple jobs, or at risk of losing their pensions. … More