Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Judgment day at Planet Fitness

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No judgment

My hotel in NYC has a decent gym, but I was looking for something more. So I visited the Planet Fitness right on the same block. I’d never been to a Planet Fitness before, but right away I noticed something odd. “Judgement free zone,” is plastered all over the place. It’s on the walls and every piece of equipment –pretty much everywhere.

Back in the day (before spell checkers) I was a good speller. I did well in the spelling bee at summer camp as a kid. (I didn’t win, because I got nervous and misspelled the word “recommend,” even though I knew better.) Still, I can usually spot a typo, and I didn’t think the American version needed that extra “e.”

Sure enough, Easy Street blogged about this very topic five years ago.

Misspellings provoke judgment from readers who catch errors. However, as with most misspellers, Planet Fitness had moved on. According to a spokesperson, “Spelling judgement with an ‘e’ started out as a mistake. Back in 1998 we considered changing it to the traditional spelling, but decided to keep it because it fit with our brand personality—we are judgment free on all matters, so what better way to demonstrate this than by keeping the original incorrect spelling.”

Who really cares? No one.

But it did get me thinking about how computerized tools and artificial intelligence can rob us of certain skills and brain function, even a they relieve drudgery and improve quality and consistency. Think about the GPS. On the one hand, it guides me to the optimal route and gives me the confidence to explore unknown areas. On the other hand, I can barely read a map these days or learn new routes on my own.

The same problems apply to healthcare providers, and I first wrote about this issue nine years ago: Are decision support tools turning doctors into idiots? If every answer is a click away or embedded into automated decision support tools, it’s hard to think for oneself.


By healthcare business consultant David E. Williams, president of Health Business Group.

Can smartphones save us from coronavirus?

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Happy Chinese New Year!

A friend came home from a business trip to China on Friday. His kids (teens and tweens) were ready to hug and kiss him when he returned –as they usually do-, but when they heard his cough they fled to their rooms, slammed the doors and donned surgical masks.

Did dad bring the coronavirus home with him? Except for his wife, no one in his family was taking that chance.

Which got me thinking, what’s changed since the last epidemics of  Ebola, avian flu and SARS…?

For one thing, cell phones and the Internet have become ubiquitous. Bad news travels fast, and there’s no keeping the kids in the dark.

On the other hand, maybe smartphones can help keep us safe. For example, I’m impressed by ResApp, an Australian company that helps doctors diagnose respiratory illnesses by analyzing the data in coughs. Is it asthma, COPD, pneumonia, or nothing serious? ResApp uses the smartphone to figure it out. (Here’s my interview with the company from 2016.)

The tool is designed to be used by healthcare professionals (probably to keep regulators from getting nervous about self-diagnosis) but it seems to me that patients could use the app themselves and just send the data over the web for confirmation, avoiding the possibility of infecting healthcare workers and other patients.

Kids are about to go back to school in Australia after summer vacation/fire season (remember they’re on the upside down part of the world), and everyone’s nervous that coronavirus will show up in the classroom.

I asked ResApp CEO Tony Keating CEO for his opinion. He said

The identification and isolation of patients with viruses such as this novel coronavirus is a critical public health step. Like SARS and MERS, 2019-nCoV causes pneumonia – an infection of one or both lungs, causing cough, difficulty breathing and/or fever. People with these symptoms can be identified (in places like airports), isolated, and sent for further molecular testing. However this screening is difficult, as not all patients with the virus may have a fever at the time and infrared thermometers are not 100% accurate. These symptoms are also indistinguishable from the usual winter illnesses such as influenza. New screening tests which are rapid, accurate and portable could improve screening, and potentially reduce the global spread of these viruses.

Sounds promising to me. Let’s hope these new solutions can come online soon.

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By healthcare business consultant David E. Williams, president of Health Business Group.

Health disparities: You ain’t seen nothing yet

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Welcome to the machine

A survey in the UK showed that the gap in health between rich and poor is widening. From the US perspective that comes as a bit of a surprise. After all, don’t the Brits have universal healthcare through the NHS?

But of course, social determinants of health such as diet, exercise, stress, access to transportation, and education play a bigger role in health than the healthcare system. With socioeconomic disparities widening, it serves to reason that health disparities will grow, too.

So where do things go from here? They probably get worse –that’s my guess. Current political and economic forces in the US, UK and elsewhere point toward an exacerbation of current gaps. And as climate change makes the world a generally harsher environment it’s the poor who will be more adversely affected by floods, fires, air pollution, etc.

But in a decade or two that will be nothing compared with the haves and have nots wrought by the advancement of medical technology. Expect the well off to increasingly invest in tools that let them get further ahead: for example cyborg inventions that augment intelligence, strength, vision, hearing and more. Not to mention artificial organs and genetic interventions to greatly extend life.

Will such modifications make people happy? Maybe not. But it will enable them to lord it over the rest of society to an increasingly greater degree.

Enjoy!

Abarca, Amgen push the envelope with outcomes-based plan for Enbrel

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Abarca COO, Javier Gonazlez

Health plans should be more willing to pay for high-cost drugs if they actually produce the results patients expect: cures, symptom relief, etc. But pay-for-outcome deals are few and far between.

Abarca Health –a small pharmacy benefit manager (PBM)– recently announced an outcomes-based deal with Amgen for Enbrel. I interviewed Abarca’s chief operating officer, Javier Gonalzez about the announcement.

This is your second deal with Amgen. How did the first one go? What did you learn from it and how did that impact the Enbrel contract?

Abarca is in the process of implementing the outcomes-based agreement with Amgen for Repatha. Because of the innovative and complex nature of these agreements, implementation takes time both with the drug maker and the health plans.

All parties have learned a lot throughout this process, and we expect implementation to get faster with new agreements. We also know that each outcomes-based contract is different. What looks like success for a patient with high cholesterol–like those who take Repatha–might not be the same for someone who is taking Enbrel for rheumatoid arthritis.

The key to a successful outcomes-based contract is collaboration–so this process has allowed Abarca to build a solid working relationship with Amgen. Our organizations are very much aligned in our belief that these agreements have the potential to disrupt the entire healthcare reimbursement system.

The Enbrel arrangement is positioned as an outcomes based contract, but the outcome is just whether the patient stops using the drug. Why not something more advanced, like a clinical measure?

Although our agreement for Enbrel will initially measure discontinuation, we will also be collecting data that drills down further into why the patient stopped treatment–which could be related to side effects, adverse events, or failure to meet therapeutic outcomes.

Though we would like to see additional clinical measures become the determining factors for outcomes-based contracts, it’s important to remember that these agreements are still very much in their infancy. Manufacturers are proceeding very slowly and picking some basic pharmacy therapy outcome endpoints that are reliable and readily accessible—medication adherence and discontinuation, for example—as they build experience.

But, as payers and PBMs build frameworks that can connect disparate patient health data points, and report outcomes through robust analytical platforms, we believe that they will be in a better position to take these agreements to the next level. To help move the industry to this point, Abarca is developing a specialty quality pay-for-performance program to establish clinical, operational, and compliance efficiencies for health plans that will create a game changing experience for patients, pharmacies, and physicians while delivering competitive pricing. We plan to announce this initiative early next year.

What interventions, if any, are utilized to encourage patients to stay on Enbrel? Do you work with any vendors to help?

Our clinical teams work closely with our clients to track adherence across all therapy classes on an ongoing basis. We also have our award-winning Medication Therapy Management (MTM) initiative and programs in place, which look at adherence for high risk patients.

Additionally, we are in the process of ramping up our offerings around the management of specialty patients. Our multi-pronged approach will feature advanced technology, and the eventual development of a quality pay-for-performance program that relies heavily on adherence as a factor to determine success. 

I’ve never heard of Abarca. How big are you? Who are your customers?

Abarca was built on the belief that with a smarter technology and a straightforward approach to business, it can provide a better experience and greater value for payers and consumers–and we’ve been delivering on that mission for more than a decade.

As a full-service PBM, Abarca’s clients include self-insured employers, Medicare and commercial plans, and large insurers across the US. We manage more than $2 billion in drug costs for 2.8 million members in commercial, self-insured, Medicare, and Medicaid plans. We also provide Darwin, our advanced technology platform that our team built in-house, to health plans and PBMs.

There have been a lot of companies claiming that they were going to disrupt or revolutionize the PBM industry. Often they use terms like “transparency” to try to differentiate themselves. But they haven’t been very successful. Why would Abarca succeed where others haven’t?

The largest players in the PBM space have found–and maintained–success by adhering to the status quo. Unfortunately, too often those practices favor the company, and not the clients and members they serve. And while some organizations may use the word transparency, we are building relationships with our clients to deliver transparency starting from day one.

For Abarca, transparency means is holding ourselves to a higher standard. It means to be able to look our clients in the eye and tell them “this is exactly what each of your drugs costs and why.” We don’t believe that transparency should be touted as a differentiator, it should be the industry standard.

Our company was founded to throw out the PBM playbook and find a better way in healthcare–and we have structured every aspect of our business in pursuit of that mission.

We have built industry-leading technology from scratch that makes PBM processes integrated, user-friendly, and modern–and has attracted the attention of some of the nation’s leading PBMs. Within a two year period, we will have doubled the size of our team to accommodate our ongoing growth. And, while many PBMs are in the process of debating outcomes based contracts, we’re executing them with some of the nation’s leading pharmaceutical manufacturers.

What other kinds of outcomes based contracts do you have in the pipeline? What kinds of drugs are good candidates?

Abarca will be focusing on high-cost, high-risk specialty medications for our future outcomes-based contracts. Specifically, we’re looking at treatments for multiple sclerosis, rheumatoid arthritis, hypercholesteremia, and breast cancer, among other disease states.

Do pharma companies want to do more of these deals? Why?

The adoption of innovative drug contracts has been slow and steady over the last few years. In fact, a recent report by PhRMA found that the list of publicly announced value-based contracts grew from 39% to 43% during 2018. But, there are several important trends that are emerging that could change healthcare significantly, including pay-for-performance, calls for transparency, and, potentially, moves away from existing rebate models.

Based on these factors, I believe that pharmaceutical companies are increasingly warming to these types of agreements. There is also the added bonus that outcomes-based agreements give drug makers critical, real-world insight into the performance of their products.

In general, pharmacy can be a very slow moving industry. But, those who are willing to innovate on their own accord–rather than industry mandate–will be in a better position for long-term success.

How about payers? What is their motivation?

Payers are really looking forward to the widespread adoption of these agreements, for a few reasons. First, it puts more accountability on manufacturers for the performance of their products. Additionally, it will help to facilitate better fact-based formulary decisions.

Today, there are a number of factors that contribute to whether or not a drug appears on a formulary but, in many cases, the process can be quite opaque. That’s not how important decisions that impact member health should be made. As outcomes-based agreements become commonplace, we will have the data necessary to manage formularies with more transparency, and objectivity. Specifically, the total impact of cost will be easier to manage and decisions can be made based on clinical outcomes, rather than pharmacy-based data points. 

Do you expect these outcomes based plans to be emulated by other PBMs? Does Abarca provide technology to other PBMs that will help?

We would hope that these types of agreements become the standard in our market. However, we recognize that not every PBM has the technology necessary to support them.

Along with being a full-service PBM, Abarca provides the technology, analytics, and reporting capabilities for health plans and PBMs to support innovative drug contracting–and other clinical initiatives. It may seem a little counterintuitive to provide what some see as our “secret sauce” to the competition, but we believe that health plans, pharmacists, physicians, and, most importantly, patients deserve a better experience–no matter who their PBM is.

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By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

Orion Health CMO Dr. Chris Hobson discusses HIE’s past, present, future

Dr. Chris Hobson
Dr. Chris Hobson

Orion Health has been the Health Information Exchange (HIE) business around the world for more than 15 years. In this podcast, Chief Medical Officer Chris Hobson and I discuss the past, present and future of health IT.

Topics include:

  • (0:12) There are a lot of buzzwords in health IT: interoperability, population health, precision medicine. What is their relevance?
  • (3:07) What new buzzwords will we encounter as we head into the new decade?
  • (8:07) Health Information Exchanges have been around for 15 years. Have they succeeded? How will they evolve?
  • (12:05) You operate around the world. What are some differences and similarities you see with the US system? What can we learn from abroad?
  • (17:00) How do the priorities of payers and providers differ?
  • (20:16) What are the implications of new legislation focusing on interoperability? TEFCA? 21st Century Cures?