What is the problem surrounding the emergence of new medications?

 

Welcome to the FDA/CMS Summit for Payers podcast series.

Below is a teaser from our recent podcast with Bill Winkenwerder, Former CEO, Highmark Inc. 

Access the complete podcast and transcript here.

Could you tell us a little bit about your background?

Bill: I trained as a Primary Care Physician and practiced for several years. I then became interested in the management of healthcare and population health. That led me to many years as a Medical Director and Chief Medical Officer and then as a Chief Operating Officer and then CEO. For several years I led the Military Health System – a very large job. I had the responsibility of caring for millions of American service members and their families. Most recently, I served as CEO of Highmark Health, which is a large, integrated healthcare delivery system.

Is there a problem with respect to the emergence of new medications that are truly effective for serious and life-threatening diseases, yet these medications are very expensive?

Bill: Yes, there is a problem. The problem is that the drugs are expensive. The problem is not that they are ineffective. In fact, that’s our challenge, that there are some really, truly, miraculous new medications that have come on the market and are going to be coming on the market in upcoming years. Targeted therapy – guided therapy – guided by pharmacokinetics and information that tells us exactly where to target the therapies. But, the problem is that these medications are expensive to develop. The pharmaceutical manufacturers have invested hundreds of millions – if not billions – of dollars into developing these medications and it’s important that they recover their costs.

So, it really does present a challenge for all of us – the pharmaceutical manufacturers, the providers, payers and government policy makers.

Download the complete podcast and transcript here.

Bill will be joining us at the FDA/CMS Summit for Payers in Washington D.C. for his closing keynote address "An Industry Perspective: Payment Policy for Clinically Valuable But Very Expensive Pharmaceuticals" on Friday December 12th. 

Register now to save an extra $100 off the current rate with the code XP1917BLOG.

See you in Washington D.C.

Rising Healthcare Costs | What are the Biggest Challenges?

 

Welcome to the Specialty Pharmacy Collaboration Summit podcast series. Joining us today is Robert Popovian, Senior Director, US Government Relations, Pfizer Pharmaceuticals. 

Download the complete podcast & transcript here.

What are the biggest challenges that you face presently with rising healthcare costs?

Robert: Well, healthcare costs are increasing. We are close to about 20% of our GDP is spent on healthcare expenditures and that number is going to continuously go up, just because of the demographics in the United States.

If you look at spending and healthcare in general with regards to pharmaceuticals, pharmaceutical spending has risen slowly and overall healthcare spending – as well as other healthcare segments in the last few years – and the price increases have been pretty much in line with the other segments of healthcare.

The challenge that we have with healthcare expenditures in the United States is that we have a very dysfunctional payment mechanism in the US where we are challenged with an outdated insurance policy model where we don’t necessarily pay for the best interventions in healthcare because of the mechanisms of reimbursement where we have pharmaceuticals vs. hospital payments vs. outpatient payments vs. other services being paid separately. Because of that, no one cost beneficial intervention is the one that is put in the front of the others.


To hear more from Robert, please join him at IIR's Specialty Pharmacy Collaboration Summit, September 15-17 in Boston. Also, you can save an EXTRA $100 off the current rate when registering with the code: XP1968BLOG - Register now. 

See you in Boston!

HDI Podcast Series with Bob Gladden of CareSource

Healthcare Data Insights Podcast Series

 Below is a teaser from our podcast series with Bob Gladden, VP for Decision Support & Informatics, CareSource

Download the complete podcast and transcript here.

How do you make data-driven decisions across the organization?
Bob: It’s been an interesting journey that we’ve been on. I think we’ve been on this like a number of other companies. I’ve heard some references to how companies are dealing with this today in terms of how decisions are made. Are they made based on individuals having data and pouring through that and coming up with a solid answer? Or is it based on what they call in the industry “HIPPOs”, which simply translates into ‘highest paid person’s opinion’. Now, we have to be careful about calling people HIPPOs. That doesn’t tend to go over well. But, we are working towards certainly the value that those highest-paid individuals have – a lot of energy and a lot of experience that they bring to the table. But, we are trying to shift a little bit so that data becomes more involved and more a part of the decision processes and use the folks that typically in the past were the highest paid person in the room just making the decision.

We’ve now focused that a little differently and we are now using them to help us identify where we need to look and put some energy into changing things. We are actually right now in the process of redesigning our entire care management process in the organization. Within that, we are actually using a very data-driven approach to even design the program, which is certainly a step forward from where we’ve been in the past. It is allowing us to step away from some of the more traditional ways that you might design a care management program.

To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago. Register with the code XP1902BLOG and save $100 off the current rate. That is $300 in total savings if you register by this Friday, 5/23. REGISTER HERE!