Will Pharmacy Benefit Manager Companies Become Obsolete?

In recent blogs, I have discussed the issues and possible innovations concerning the ever-increasing costs of medications and the new payment mechanisms that might improve the situation. The role of the Pharmacy Benefit Manager (PBM) continues to come into question, and the evolution of the industry is much needed. Interestingly, in 2017, the top PBMs had revenues that… Read More »

How Can Medicare Hold Down Drug Prices?

There is a significant amount of discussion concerning the prices of drugs. For example, the spending on pharmaceutical treatment of cancer has increased $19 billion from 2012 to 2016. Price growth continues, and analysts estimate that by 2021, 25% of all new pharma research will be on cancer treatment and 87% of this growth will be on targeted,… Read More »

Can Value-Based Pricing Counteract the Rising Costs of Drugs? Part 2

As discussed in a previous blog, using true value-based drug pricing will require us to implement an agreed-upon benchmark such as Quality Adjusted Life Years (QALY). The Institute of Clinical and Economic Review (ICER) is an organization that attempts to incorporate qualitative information gathered through public engagement, QALYs, price estimates that may vary with the size of a… Read More »

Can Value-Based Pricing Counteract the Rising Costs of Drugs? Part 1

In continuing our conversation concerning value-based pricing of services, we would be remiss if we neglected to focus on the escalation of drug prices. Even now, treatments exist for various diseases that are swiftly approaching the $1,000,000 mark. With increasingly more of these agents coming to market, we can rapidly discern a time where the cost of our… Read More »

Are There Alternatives to Physician Practice Consolidation?

The need for physicians to have focus on not only the delivery of care but also the ever-increasing complexity of running a practice has led to the consolidation of physician practices and increased employment of physicians. Recent legislative changes, including the Quality Payment Program and the drive towards value-based payment models, compound the reasons for the slow demise… Read More »

Funding health and wellness through a balanced portfolio

Investment strategies come in various forms and fashions. But the common thread among them all is the desire to have a balanced portfolio, creating the greatest growth and wealth over time. It is interesting to think about the investment strategies of our health and wellbeing in the same manner. Currently, we heavily invest in certain areas. There is… Read More »

Defining a population is important if we are to control costs

“Population health” is a phrase used with ever-increasing frequency. However, depending on who you might ask, the definition varies. For example, the description of a population for a hospital would be any person that is in a bed. For a physician practice, any person under their care would be more appropriate. And then, for a payor or an… Read More »

Our professional societies are not doing us any favors

Being a physician and aspiring to treat those we serve within the realm of evidence-based medicine is difficult. One of the things that can feel hard to manage are all the messages from the various medical societies.  Though we rely on our specialty societies to aid us distinguishing between valid or inadequate research and informing us about new… Read More »

Do we spend too much on healthcare?

We all are aware that our level of spending of healthcare in the United States in greater than any comparable country without a corresponding improvement in results.  Either as individual payers or being participants within our present tax system, including tax relief of employer-sponsored health insurance, collectively we are responsible for the cost of our healthcare. A recent… Read More »

Good communication skills are increasingly important

As we continue to focus on shared decision making within the context of value-based care, one of the primary goals is the prevention of over treatment through better communication. To improve our conversations, we must first unearth any underlying components that impact both the patient and the provider. Disease uncertainty and management choices can evoke strong psychological reactions… Read More »