Do Value-Based Insurance Designs Work?

As discussed on The Positive Contrarian before, there is a tremendous focus on innovating our insurance payment models to deliver value, improved quality and service at a lower cost. The success of value-based insurance design (VBID) is dependent on two factors. The first dynamic is the unknown impact of the consumers’ responses to out-of-pocket spending, or “elasticity of… Read More »

Why Does Equity Matter for Equality in Healthcare?

One of my favorite images is a picture of three boys standing behind a fence trying to watch a baseball game. One is tall enough to gaze over the fence; the other two are of different heights, and unable to glimpse the action. There are three boxes stacked next to them. The question posed is “How would you… Read More »

Why VALUE is Important to Population Health?

“Population Health” has numerous definitions. Most commonly it is “Health outcomes of a group of individuals, including the distribution of such outcomes within the group.” The key words are “health” and “group.” At the most expansive level, the wellness of our entire society encompasses this meaning. There in deciding to define the value to include the whole community… Read More »

Continuous Insurance Coverage Leads to Better Health

A recent study by Rogers et al appeared in Health Affairs, “Interruptions in Private Health Insurance and Outcomes in Adults with Type 1 Diabetes: A Longitudinal Study.” The findings indicated that for those with chronic diseases (Type 1 Diabetes in this case), the loss of insurance exacerbates their condition markers and lowers one’s perceived health and satisfaction with… Read More »

Will Technology Ever Improve Healthcare?

In most industries, technology has been credited with driving innovations and improving the productivity and quality of products and services we utilize every day. Unfortunately, Healthcare has not experienced this same occurrence. There are numerous cutting-edge technologies occurring in healthcare, but one must question if the value of care has progressed? Has technology provided a marked increase in… Read More »

Personal Responsibilities and Healthcare Coverage

There is a conversation occurring concerning the ability of states to administer specific personal responsibility requirements on Medicaid beneficiaries to receive coverage benefits. This discussion is relevant as it relates to the Medicaid Work Requirements that states are currently proposing. A seemingly simple notion on the surface; recipients must meet specific requirements as a condition of their coverage,… Read More »

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 »