E.V.I.dently February 2020

Message From NPC

Continuing Efforts to Reduce Low-Value Care

While the need to eliminate spending on low-value or unnecessary health care garners easy agreement among stakeholders, the task of eliminating those services is far more elusive. Low-value care is a $340 billion problem in the United States and the focus of a webinar hosted on Feb. 15 by the Going Below The Surface (GBTS) Forum, in conjunction with AcademyHealth and the National Pharmaceutical Council (NPC). The webinar served as an initial opportunity to discuss a low-value care roadmap being developed by the GBTS Forum to provide practical guidance for stakeholders in addressing this important issue. The next opportunity to discuss the roadmap will be on April 8, during a webinar discussion hosted in conjunction with a GBTS Forum partner, AMGA. Stay tuned for further details.

NPC Now: A Look at Our Latest Work

Can We Measure Caregiver Burden and Other Indirect Benefits in Value Assessments?

What prevents consideration of broader individual and societal benefits when assessing the value of innovative medical treatments and making health care coverage determinations? In new research published in the Journal of Occupational and Environmental Medicine, researchers at NPC and RTI Health Solutions surveyed health insurance providers, pharmacy benefit managers, employee benefit consultants and employer groups to identify barriers and solutions to evaluating four indirect treatment benefits: absenteeism, presenteeism, caregiver burden, and quality of life.

Webinar On-Demand: Driving Evidence-Based Health Plan Coverage by Recognizing Gaps, Updating Practices

How consistently are health plans drawing on best available evidence to inform coverage decisions? During a webinar on Feb. 13, experts from NPC and the Tufts Center for the Evaluation of Value and Risk in Health discussed their recent study published in Health Affairs that revealed significant variation in the consistency, volume and type of evidence being cited by U.S. commercial health plans in coverage decisions for specialty medicines. Listen to the webinar on demand to learn about the gaps researchers found and opportunities to address them.

Panel Tackles Tradeoffs in Health Spending

At the AcademyHealth National Health Policy Conference on Feb. 11, health policy experts tackled a critical question: how do we spend our health care dollars effectively and understand possible tradeoffs? Moderated by NPC Chief Science Officer Robert Dubois, MD, PhD, panelists from Vanderbilt University, the Health Care Cost Institute, the National Alliance of Healthcare Purchaser Coalitions and the Council for Affordable Health Coverage discussed issues ranging from the cost burdens patients face with out-of-pocket costs and the potential unintended consequences of financial incentives embedded in the health care system. The discussion addressed topics related to health care spending being explored by the Going Below The Surface Forum, a group of 20 diverse organizations

Other Research and Info

ICER Releases Updated Framework  

On Jan. 31, the Institute for Clinical and Economic Review (ICER) released its updated Value Assessment Framework, which will guide the organization’s reviews of medical treatments through 2023. During the comment period, NPC had flagged key areas for improvement, calling on ICER to consider issues including societal perspectives on treatment benefits, assessment of broader health system issues vs. a narrow focus on biopharmaceuticals, and the potential pitfalls of using Quality-Adjusted Life Years (QALYs) as the threshold for cost-effectiveness. Read how these important considerations were reflected in ICER’s updated framework and the challenges that remain.   

ICYMI: Articles of Note

  • Lin SC, Yan PL, Moloci NM, et al. Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending in Medicare ACOs. Feb. 2020, Health Affairs

  • Collins R, et al. The Magic of Randomization Versus the Myth of Real-World Evidence. Feb. 13, 2020, The New England Journal of Medicine

  • 2018 Health Care Cost and Utilization Report, Feb. 2020. Health Care Cost Institute.

Events

Webinar: “Getting to the Heart of Health Care Spending: What’s Been the Bang for the Buck?” How do medical advances in cardiovascular disease impact the health care spending picture? Register today for a discussion with NPC and health policy experts from Harvard, Brigham and Women’s Hospital, and RTI Health Solutions on Thursday, Mar. 12, 1 p.m. - 2 p.m. ET. 

eyeforpharma Philadelphia 2020 – At the Apr. 15-16 conference, NPC’s Dr. Dubois will join a panel focused on how to “Build a Sustainable Value Model.” He and fellow panelists from ICER, Biogen, AstraZeneca and HealthVerity will discuss ICER’s 2020 Value Assessment Framework, valuing high-cost, but transformational therapies, and developing approaches that address affordability and patient access.

FT US Pharma and Biotech Summit  – This Financial Times summit will convene discussions with senior industry leaders to explore the theme, “Pharma in the Age of Value and Affordability,” on May 14, 2020 in New York City. The agenda will feature speakers from NPC member companies including Genentech, Pfizer, Janssen, Eli Lilly and Company and Merck.