Project ECHO: The Evidence Is Catching Up With The Enthusiasm
Enthusiasm can be a double-edged sword, as Christopher Langston notes in his recent critique of Project ECHO. He describes the model’s success as a case of enthusiasm overtaking evidence.
It’s true that the spread of ECHO has outpaced the publication of the research exploring it.
The enthusiasm of specialists and primary care providers engaged in this model of collaborative practice and mentorship has spurred tremendous momentum for ECHO all over the world. In fewer than 14 years, Project ECHO, which I developed with my colleagues at the University of New Mexico Health Sciences Center as a way to help people with hepat...
Source: Health Affairs Blog - January 13, 2017 Category: Health Management Authors: Sanjeev Arora Tags: Featured Health Professionals Organization and Delivery Population Health Public Health Quality Primary Care Project ECHO Source Type: blogs
OIG Report Addresses High Federal Spending on Catastrophic Part D Coverage
Conclusion
OIG concludes that “securing the future of the Part D program while ensuring beneficiaries have access to needed drugs is a complex issue that calls for a multifaceted approach.” CMS recently published information about certain drugs with substantial increases in price, noting that action is necessary to address rising drug costs and asked the industry to partner with the agency to find solutions that allow for both innovation and affordability.
In the future, CMS will likely look for additional tools to address and meet those goals. Some potential tools mentioned include restructuring the Part D benefit s...
Source: Policy and Medicine - January 8, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Analysis Shows Health Care Cost Predictions Grossly Incorrect
This study, once again disproves the misleading claims that pharmacy benefit managers and insurers (among others) make about spending on new innovative medicines. The report found that predictions of health care costs made prior to the introduction of new medicines were often dramatically overstated.
The study points to the example of new cholesterol-lowering medicines, also known as PCSK9 inhibitors. The Institute for Clinical and Economic Review (ICER) predicted that the one-year cost of the two PCSK9 inhibitors would be $7.2 billion. However, in reality, based on reported sales, the actual cost will be approximately $8...
Source: Policy and Medicine - January 5, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Project ECHO: Enthusiasm Overtakes Evidence
Project ECHO (Extension for Community Healthcare Outcomes) is a popular model for improving patient outcomes through provider education, which has grown rapidly since its initial success in the treatment of Hepatitis C. Recently, the U.S. Senate passed the ECHO Act, calling for the Secretary of Health and Human Services to examine the model and implicitly to spread it through existing programming. Unfortunately, the evidence of the benefits of ECHO appear to be far more limited than is generally understood and we are in substantial danger of making public policy decisions without adequate clinical results, much less cost-e...
Source: Health Affairs Blog - January 3, 2017 Category: Health Management Authors: Christopher Langston Tags: Featured Health Professionals hepatitis C Physicians Primary Care Project ECHO Source Type: blogs
Investigating Mechanisms of Age-Related Increase in Fibrosis
Fibrosis is a form of scarring, important in many medical conditions, notably those of the liver, and a process that increases in many internal organ tissues with advancing age. Inappropriate levels of cellular construction of fibrotic structures disrupts the proper function of tissues, leading to dysfunction and disease. Researchers here look into the underlying mechanisms driving that age-related increase in fibrosis, and suggest that the problem lies in a reduced ability to clear out fibrosis rather than an increased tendency to generate these structures in response to damage. The researchers point to the presence of cr...
Source: Fight Aging! - January 3, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
ECHO Improves Rural Physician Access to Subspecialty Expertise
The Project Extension for Community Healthcare Outcomes (ECHO) was started at the University of New Mexico School of Medicine, after several noticed extraordinarily long waits for hepatitis C care in New Mexico. The effort has resulted in an international effect, with more than ninety hubs participating in the effort, offering subspecialist guidance to primary care physicians, nurses, and other clinicians across the United States and in twelve other countries.
The hub-and-spoke model used in ECHO had previously been used to transform the field of aviation, and is now being applied to the continuing education of primary ca...
Source: Policy and Medicine - December 21, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Breaking Down The Final 2018 Letter To Issuers
Editor’s note: The final 2018 Letter To Issuers In The Federally Facilitated Maketplaces, discussed below, was issued in conjunction with the final 2018 Benefit and Payment Parameters rule, discussed here and here.
On December 16, 2016, the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS) released its final 2018 Letter to Issuers in the Federally Facilitated Marketplaces (FFM). CMS releases a letter each year to insurers that offer coverage through the FFM or through state-based marketplaces that use the Healthcare.gov platform (SBM-FP), laying out the ground rule...
Source: Health Affairs Blog - December 19, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Payment Policy Source Type: blogs
CMS Finalizes New Marketplace Payment Rule, Effective January 17, 2017
Late in the day on December 16, 2016, the Centers for Medicare and Medicaid Services (CMS) finalized the Benefit and Payment Parameters rule for 2018. (fact sheet). It also released the final 2018 Letter to Issuers in the Federally Facilitated Marketplaces.
Accompanying the rule and letter, CMS also released a number of additional documents, including
guidance on the uniform rate review timeline,
a list of key dates for 2017,
the final actuarial value (AV) calculator for 2018 and AV calculator methodology,
a guidance regarding age curves and state reporting,
a frequently asked question (FAQ) on second-lowest cost silver p...
Source: Health Affairs Blog - December 18, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Payment Policy benefit and payment parameters Congressional Review Act federally facilitated marketplaces letter to issuers Source Type: blogs
National Health Spending: A Return To The ‘ Old Normal? ’
The year 2015 may be the year that we said goodbye to what some have called the “new normal” of health care spending. It’s becoming ever more clear that the unexpected and remarkably consistent slowdown in health care spending that began in the early 2000s is over. According to updated data from the economists and statisticians at the Centers for Medicare and Medicaid Services, 2015’s health spending hit $3.2 trillion, growing at 5.8 percent from 2014. That edges us ever closer to the growth rate just before the Great Recession, when health spending grew around 6.5 percent.
But as we return to the “old normal”...
Source: Health Affairs Blog - December 14, 2016 Category: Health Management Authors: Yevgeniy Feyman Tags: Costs and Spending Following the ACA CMS national health spending Source Type: blogs
Hepatitis C Treatment Continues to Amaze; Need to Screen Baby Boomers
Regarding the treatment of hepatitis C, I confess that I have been distracted in recent months by the controversy surrounding the cost of treatment and not paid sufficient attention to the incredible success with the treatment (see:Hep C Treatment Prognosis Continues to Amaze). Below is a quote from this article:Rapid advances in the treatment of hepatitis C have clinicians seeing outcomes they never thought possible, and experts are optimistic that more complex and challenging patients will respond to therapy. However, treatment choice can be tricky. And caveats are emerging, including reports that direc...
Source: Lab Soft News - December 14, 2016 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Clinical Lab Industry News Clinical Lab Testing Cost of Healthcare FDA Health Economics Laboratory Industry Trends Medical Consumerism Medical Research Pharmaceutical Industry Source Type: blogs
Sexually transmitted infections on the rise
Recently I saw a young woman in my clinic for her annual exam. As usual, I asked her if she would like to be tested for sexually transmitted infections, and then we reviewed the “menu” of options: we could collect a swab of her cervix for chlamydia, gonorrhea, and trichomonas, and a PAP smear for human papillomavirus. We could collect blood for HIV, hepatitis C, syphilis, and herpes. We discussed the pros and cons and details of testing — not everyone wants every test. But she cheerfully consented to all of it, and when the results came back positive for chlamydia, she was shocked.
“But I had no symptoms!” she ex...
Source: Harvard Health Blog - November 28, 2016 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Health Infectious diseases Prevention Sex Sexual Conditions Source Type: blogs
The Cost Of A Cure: Revisiting Medicare Part D And Hepatitis C Drugs
Two years ago, soon after the Food & Drug Administration (FDA) approved the first breakthrough treatment for hepatitis C, we wrote about the potential cost of a cure to Medicare Part D and its beneficiaries. For that piece, we used the best available data to estimate the number of people on Medicare who might seek treatment and the impact on Medicare spending. Here we revisit our earlier analysis using new data released by CMS, and consider both the ongoing impact of hepatitis C drugs for Part D and the broader implications for Medicare of new high-priced drugs entering the market.
Hepatitis C Drugs Have Driven Drug Sp...
Source: Health Affairs Blog - November 3, 2016 Category: Health Management Authors: Jack Hoadley, Tricia Neuman and Juliette Cubanski Tags: Drugs and Medical Innovation Medicare FDA Harvoni hepatitis C prescription drug prices Sovaldi Source Type: blogs
5 obstacles to texting patients
The business value of medication adherence tools is coming into focus. For years, I remarked that, while we could create a case for why adherence was the right thing to do, we had great difficulty creating the right financial incentives to move these programs from curiosity to scale. That is changing now with the collision in the marketplace of new payment models and exorbitantly priced pharmaceutical products.
The poster child for this phenomenon is the drug Sovaldi, which represents a miracle cure for hepatitis C infection but costs $84,000 for a course of therapy. But if the patient doesn’t finish the entire cou...
Source: Kevin, M.D. - Medical Weblog - November 1, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/joseph-kvedar" rel="tag" > Joseph Kvedar, MD < /a > Tags: Tech Health IT Mobile health Source Type: blogs
Not So Wondrous Drugs? - New Warnings about Severe Adverse Effects of New, Heavily Marketed Drugs for Hepatits C,
In conclusion, evidence-based medicine rigorously applied suggests that individual health care and health policy decisions should be driven by the best available evidence, mostly from clinical research, about the benefits and harms of tests, treatments, programs, and so on, in the context of what outcomes matter to patients. The skepticism EBM should engender could lead to health care that is more about patients and their outcomes, and less about ideology, hype, and hucksterism. If only such skepticism were easier to find........APPENDIX - Clinical Research about Hepatitis C TreatmentsStarting in March, 2014, we havep...
Source: Health Care Renewal - October 6, 2016 Category: Health Management Tags: adverse effects clinical trials deception evidence-based medicine Gilead hepatitis C marketing Sovaldi Source Type: blogs
Value: Can We Afford To Think Long-Term While Ignoring Budget Impact?
In their Health Affairs Blog post, Darius Lakdawalla and Peter Neumann raise numerous concerns about the inclusion of potential budget impact estimates alongside what they view as more traditional analyses of the “value” of a health care service. They advocate instead for increased experimentation with new forms of payment and delivery of care.
I agree that these experiments have the potential to improve value for patients and the health care system in the future. But I believe Lakdawalla and Neumann underappreciate how budget impact analyses can help catalyze innovative pricing and payment approaches. I will expand on...
Source: Health Affairs Blog - September 22, 2016 Category: Health Management Authors: Steven Pearson Tags: Costs and Spending Drugs and Medical Innovation Featured Payment Policy cost-effectiveness ICER Source Type: blogs
