Smarter deductibles?

Are high deductible health plans a good thing?  Republicans typically argue yes as they say that increased cost sharing reduces moral hazard.  That is, when people have to pay for medical care out of pocket, they don’t ask for unnecessary care or use care more frugally.  Democrats typically argue that increased cost sharing reduces demand…

Advancing Value in Healthcare

Rapid biomedical progress and rising healthcare costs have led to increasing calls to link spending to value rather than volume of care in the United States. These calls have come from payers, patients, providers, and even innovators. For example, Medicare aims to link 90% of payments to some form of value-based reimbursement. Providers-based organizations such…

Measuring Quality in Cancer Care

Identifying high-quality, cancer care is a laudable goal.  However, a recent article by Alvarnas (2016) says the way many are trying to measure quality of cancer care currently is inadequate.  Specifically: Quality and value are multidimensional, but the narrow focus of many quality measures undermines their effectiveness and meaningfulness. (Porter 2010) Quality and value measures are all…

Patient perspective on cancer care funding

Improvement in survival (a.k.a. efficiacy) clearly are important, but what other factors matter?  According to a systematic literature review by MacLeod, Harris and Mahal (2016), these factors include: patients favour funding for cancer medicines that improve health outcomes demonstrated by ‘clinical efficacy’ [Oh et al.], ‘prolonged survival’ [Goldman et al., Seabury et al. Lakdawalla et al.] and/or…

What is MACRA?

MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’.  Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions. Although physicians may take comfort in avoiding the year end doc…

NCCN Evidence Blocks

NCCN recently released a new approach to measure the value of cancer medicines. The approach–known as Evidence Blocks–evaluates medications on 5 dimensions: Efficacy of regimens, Safety of regimens, Quality and quantity of evidence for regimens, Consistency of evidence for regimens, and Affordability of regimens. Each criteria is ranked on a 1 to 5 block scale.…

ACC/AHA Statement on Measuring Treatment Value

The conventional premise governing performance measures and guideline recommendation…is that all healthcare professionals should act in the best interests of their patients without regard to costs. However, as the cost of medical care has increased, specialty societies are increasing considering the cost of care when selecting treatments. For instance, A recent survey reported that slightly…