Our nation’s ongoing health care debates have been rancorous, a situation that’s not likely to improve in 2020 with a presidential election. Rather than make predictions in this column, this year I’m outlining a wish list for the health care sector, actions we can all take to make health care more efficient, reduce wasteful spending, ensure greater value for our health care dollars, and break down barriers that block patient access to medicines.
Before we roll up our sleeves and get to work on these actions, we must have an honest and open dialogue about the many drivers of health care spending and costs. Some groups have been willing to stop the finger-pointing and get the work done. That’s why my organization, the National Pharmaceutical Council, started Going Below the Surface, our national initiative to understand the roots of the country’s health care investments and provide clarity on how to maximize return on those investments in health. In the past year, we took the discussion to the local level, holding several regional town halls. The message from participants was clear: While the national conversation has been intensely focused on the cost of care, it’s more important to focus on getting the maximum value for the dollars spent. In fact, sometimes it makes sense to spend more up front in certain areas, such as preventive care, especially when the expenditure serves a public good.
Assessing the value of certain interventions is challenging, however. Although several organizations have created value assessment frameworks, measuring value is still an evolving practice in the United States. These frameworks must be transparent, consider patient and caregiver inputs, include societal benefits, and rely on a strong evidence base. One size doesn’t fit all — we need a variety of perspectives to help us make the best decisions. There are ongoing debates about whether to import international pricing indexes as a way to address value and pricing issues, but these are not the answer: What may work in other countries with smaller populations and different structures will likely not fit in the United States, and could have detrimental effects on the innovation base in this country.
How we pay for value is also key. There are promising market-based approaches, such as value-based arrangements and indication-based pricing, which are currently in use but could be more broadly adopted. And states are trying different experiments with creative financing mechanisms, as we are with MIT’s NEWDIGS program, but there’s only so much we can do within the limitations imposed by Medicaid Best Price regulations. It’s time to modernize those regulations, especially at a time when there are cures for sickle cell anemia and disease-modifying therapies for Alzheimer’s on the horizon. These are the types of treatments that patients and insurers have been seeking for years. The biopharmaceutical sector is delivering, and we need to ensure patients and their caregivers can fully benefit.
What we pay for matters too. We must reduce low-value, or ineffective, care. Although it’s hard, it’s not impossible. When we tackle medical errors, administrative complexity, overuse and overtreatment, the savings could be used for so much: offering enhanced coverage for high-value clinical care or establishing the means to provide long-term care, services and support that the growing senior population will soon require.
Another item at the top of my wish list is improving access to care by recognizing and addressing the impact of social determinants of health. In North Carolina, for example, we’re seeing some innovative pilot projects aimed at reducing hospital visits. There, insurers are working with the state to remove carpets and replace air filters in asthma patients’ homes, reducing the number of asthma attacks and emergency room visits significantly.
The use of quality evidence in decision making is a perennial goal for NPC that transcends the changing of the calendar. The Food and Drug Administration is increasingly incorporating real-world evidence, in which the experience of patients and caregivers is considered; its broader adoption is on my wish list. We also need high-quality methodology and standards to conduct that real-world research and to help decision makers understand how to evaluate and use the resulting data.
Dan Leonard is the president and CEO of the National Pharmaceutical Council.