On behavioral change, health and age
A Health Affairs article (Meyer 2021) discusses the potential benefits of Medicare Diabetes Prevention Programs (MDPP). MDPP aims to reduce patient weight and prevent patients from becoming diabetic. Commenting on her Medicare clientele enrolled in the program, one instructor noted:
MDPP was the first Center for Medicare and Medicaid Innovation (a.k.a., CMMI; a.k.a., the CMS Innovation Center) demonstration of a preventive care model that was expanded to program available to al Medicare beneficiaries. However, uptake of the program is poor; only 3,600 Medicare beneficiaries across the nation have taken advantage of the MDPP benefit. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/11/on-behavioral-change-health-and-age.html November 03, 2021 at 12:45AM
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How much money should governments spend to incentivize the development of new antibiotics?11/2/2021
How much money should governments spend to incentivize the development of new antibiotics?
As the number of infections that are anti-biotic resistant grows, we need to have more novel antibiotics in our arsenal. The problem is that many antibiotics are not commercially viable. For instance, if a new antibiotic is marginally better than the existing one, few payers will be willing to cover this cost. However, if new bacteria become resistant to the standard of care antibiotic, then the novel antibiotic would be highly valued. In short, antibiotics have a very high option value. There have been a number of approaches to try to incentivize new R&D on antibiotics, including various prizes and subscription models.
A key question is how large these incentives should be. Some previous literature have proposed the following amounts:
A paper by Outterson (2021) in Health Affairs published today aimed to update these estimates. He creates a net present value (NPV) calculation which depends on development cost (i.e., cost, duration and probability of success for any phase in the drug development process); revenues and expenses after antimicrobial approval; and the discount rate. The authors models different approaches to reach the NPV: based on global peak year sales (GPYS); based on a market entry reward paid in one year (MER1); based on subscription paid over ten years (SUB10); of based on the acquisition of a Phase II-ready asset (AQ). Using these approaches, Outterson finds that:
The authors find that subscriptions are more expensive because (i) subscriptions are delinked from actual volumes and thus manufacturers must make the drugs without potentially any compensation (beyond the subscription); and (ii) payments are pushed into the future and thus additional funds must be found to compensate for the reduced time-cost of revenues received in the future. They also find that push incentives alone are typically insufficient to bring new antimicrobials to market. The article is interesting throughout and do read the whole article here. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/11/how-much-money-should-governments-spend.html November 03, 2021 at 12:45AM
Vaccine hesitancy in low- and middle-income countries
While the recently developed COVID-19 vaccines offer the hope of ending the pandemic, ending the pandemic is only feasible if individuals take the vaccine. In the US, a large portion of individuals report being hesitant to receive the vaccine. A key question then is whether individuals living in low and middle-income countries (LMIC) are have high rates of vaccine hesitancy. A paper by Solís Arce et al. 2021 answers this question by conducting a survey of nearly 45,000 individuals living in 10 LMICs, Russia and the United States. The authors find that: , including a total of 44,260 individuals
Across individuals who were willing to take the vaccine, the main reason for taking the vaccine was personal protection, with family protection typically coming in second place. Across individuals who were not willing ot take the vaccine, the main reason was concern over side effects, although some countries (Mozambique, Uganda and Pakistan) noted skepticism over vaccine efficacy. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/11/vaccine-hesitancy-in-low-and-middle.html November 03, 2021 at 12:45AM
Mid-week reading
via Blogger http://jeanxrussell.blogspot.com/2021/10/mid-week-reading.html October 28, 2021 at 03:45PM
Characteristics of neighborhoods with high and low COVID-19 vaccination rates
What do the vaccination rates look like in the largest U.S. cities? In these cities, how do the characteristics of individuals in neighborhoods with low vs. high vaccination rates differ? To answer this question, a paper by Sacarny and Daw (2021) use data from 9 large US cities: New York, Los Angeles, Chicago, Houston, Phoenix, Philadelphia, San Antonio, San Diego, and Dallas. Specifically, they gather data on COVID-19 vaccination and death rates for these cites from health authority websites and sociodemographic information from the American Community Survey (ACS). They find that neighborhood with high vaccination rates have: (i) more Whites and Asians and fewer Blacks and Hispanics, (ii) more people who received a bachelor’s degree or higher, and (iii) higher income levels, (iv) a higher share of individuals aged 65 and above. Unsurprisingly, COVID-19 deaths are lower in the highly vaccinated neighborhoods in these cities. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/10/characteristics-of-neighborhoods-with.html October 27, 2021 at 01:45PM
Cato supports public option?
A white paper from Cannon and Pohida (2021) calls for applying “public option principles” to Medicare. Who would have thought that the Cato Institute would call for a public option? Well in fact, the do not really call for a public option. The proposal should be called introducing a voucher system into Medicare. Under the proposals, Medicare beneficiaries would receive a fixed voucher–adjusted for income and health status–that individuals could used to pay for premiums for whatever insurance they choose, public (Medicare Fee-for-service) or private (Medicare Advantage). The approach is not too dissimilar from one previously proposed by the American Enterprise Institute (AEI) titled “The Best of Both Worlds.” The authors authors explain why they believe this would be a useful system, writing:
A key issue is how well can people shop across plans. Are quality measures clear? Are the meaningful? Are they free from provider gaming? The authors cite a paper where Don Berwick–a former CMS administrator–notes that the current provider payment schemes may not incentivize quality.
As I posted recently, Medicare now has a large number of value-based programs, but not many of these alternative payment models have had a large impact on quality. The authors claim that the voucher-based system will lead to more creative ways to pay providers.
Also, more standardization of health plans makes it easier to shop across plans; standardizing, however, leads to less innovation as well. The major underlying assumption is that by allowing more competition, cost should fall and outcomes should rise. Skeptics would point out that administrative costs will likely rise as health plans compete and there could be more cost savings with a single payer option. While the later point is valid in a static setting; over the long-run competition tends to be the most effective way to bring down cost. Another key issue is, how does one adjust for health status and income? While in principle this is easy to do (Medicare Advantage already has their subsidies from CMS risk-adjusted for health status), in practice health systems and insurers may have more information than does the government when making this adjustment. Further, transitory employment shocks–while less of an issue for the Medicare population–can make estimating individual income a challenge. Despite these numerous challenges, the idea is interesting and the white paper is worth read. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/10/cato-supports-public-option.html October 26, 2021 at 04:45AM
Weekend Reading
Here are some questions to get your weekend reading started.
via Blogger http://jeanxrussell.blogspot.com/2021/10/weekend-reading.html October 24, 2021 at 01:45AM
Part D Senior Savings Model: What is it?
If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? Well it is. Medicare Part D beneficiaries have a deductible, then the standard coverage phase with 25% cost sharing, then a coverage gap where beneficiaries pay 25% of cost (manufacturers cover 70% of the cost for branded drugs in this coverage gap), and then a catastrophic phase where beneficiaries pay 5%. Wouldn’t it be easier if there were simple copayments like many commercial plans? That is what CMS has been trying out in their Part D Senior Savings Model. The model includes fixed copayments for certain enhanced Part D plans. CMS writes:
As described by former CMS administrator Seema Verma in the Health Affairs blog:
Sharon Jhawar, Chief Pharmacy Officer at the SCAN Health Plan argues that the Senior Savings Model is working, should be made permanent, and should be expanded to both other diabetes medications and medications used to treat other common chronic conditions. Previous research shows that cost is a barrier to medication adherence, and she writes:
For more information, read the CMS Senior Savings Program Fact Sheet and visit their website. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/10/part-d-senior-savings-model-what-is-it.html October 23, 2021 at 12:45PM
CMMI and its revised strategy
Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been tasked with creating new reimbursement strategies to improve quality and decrease costs. Over the past decade, CMMI has tested over 50 new payment models, and in just the last 3 years (2018-2020) CMMI models have reached almost 28 million patients and over half a million health care providers and plans. Despite these ambitious goals, CMMI reports that “only six out of more than 50 models launched generated statistically significant savings to Medicare and to taxpayers and four of these met the requirements to be expanded in duration and scope.” In their recently released white paper “Innovation Center Strategy Refresh.” CMMI claims to have learned the following lessons:
Some interesting points from the report include:
The above seems obvious, but previously, beneficiaries were attributed to physicians typically based on the number of physician visits (often just evaluation and management [E&M] visits). This meant that some patients who would be overseen by a specialist during an acute bout of a disease would be then held responsible for all of a patient’s cost. Further, neither the patient nor the provider would know to which physician the patient would be attributed. While this approach may seem confusing, the benefit was attribution could be done passively; while more active attribution probably makes sense, it is unclear whether patients will actively select providers to manage their care or what will be needed to incentivize patients to do so.
A key question is how CMS will do this. One approach would be to set lower quality or less strict cost evaluations for these types of providers. While doing so would make participation in alternative payment models more attractive, it would also create a two-tiered system with lower quality standards for disadvantaged beneficiaries in HPSA and MUAs who are often treated at FQHCs, HCS and other safety net providers. CMMI have not spelled out explicitly how they plan to accomplish this equity quote. The only concrete action CMMI mentions is collecting data on race, ethnicity and geography to examine health disparities.
This is clearly a good idea. How to implement more patient-centered care, however, is a challenge. It is good to see that CMS is considering allowing for payment flexibilities around telehealth going forward, but it is not clear why this flexibility would only be extended to providers in total cost of care models; all providers should be able to leverage telehealth to improve patient access and outcomes, not just those in total cost of care models. CMMI also proposes to lower beneficiary out-of-pocket cost spending, but focuses only on increased use of generic and biosimilars. The Innovation Center also calls for the use of value-based insurance design (VBID). While VBID is sensible, health economic analysis will be needed to determine what treatments qualify as “high-value” and would be subject to low patient cost sharing. To achieve some of these goals, the CMS Innovation Center aims to go ‘all-in’ on value-based reimbursement and is attempting to expand these payment schemes beyond Medicare. Specifically, they aim to measure their progress as follows:
Below is a table describing how CMS will measure success for different stakeholder groups. There is much more in the white paper and you can read the full document here. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/10/cmmi-and-its-revised-strategy.html October 22, 2021 at 05:45PM
The Pitfalls of Cost Sharing in Healthcare
Cost sharing is just that, sharing in the cost of providing a health care service. While health insurers often pay for a large share of health care cost (for those covered), individuals also contribute through deductibles, copayments and coinsurance. The goal of cost sharing is to reduce moral hazard. Moral hazard occurs when the price of a good is below its marginal cost, people will consume more of it. However, because the benefits of health care treatment are often long-term, can be difficult to observe, and often come with side effects, the costs and benefits that a patient observes may not be the same as the actual cost of production and cost sharing may discourage the use of cost-effective, high-value medical or pharmaceutical interventions. This video was adapted from a column written at the Upshot and links to sources can be found there. Via Dental Tips http://www.rssmix.com/via Blogger http://jeanxrussell.blogspot.com/2021/10/the-pitfalls-of-cost-sharing-in.html October 20, 2021 at 02:45PM |