The Lynx Group

Value Peer-spectives

In today’s fast-paced healthcare environment, managing health benefits requires dexterity, foresight, and collaboration. At the inaugural multistakeholder Employer-Provider Interface Council (EPIC) of the Hospital Quality Foundation interactive Leadership Conference that took place on June 11, 2019, the relationships among employer plan sponsors, employee healthcare consumers, and healthcare providers were explored. To understand how health benefits are managed to deliver value to stakeholders, several speakers discussed the importance of how to define and derive value in the rapidly changing healthcare industry. Each presentation was followed by reactions from a stakeholders panel from various segments of the healthcare industry, including consumer advocacy, employer, payer, government, and provider.
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dding trastuzumab to standard cisplatinum/fluoropyrimidine chemotherapy for patients with HER2-positive advanced gastric cancer results in a median survival of 13.8 months, compared with 11.1 months with chemotherapy alone, according to a new study (Lancet. 2010;376 [9742]:687-97. Epub 2010 Aug 19).
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It is no surprise that healthcare costs are at an all-time high and continue to take center stage in political, social, and economic debates. Employers, as health plan sponsors and as purchasers of care, are looking to take matters into their own hands and tackle the problem through innovative reimbursement strategies. Not all employers, however, are built the same. Experiences in controlling healthcare costs vary between small and large employers. The most affected employers are in the middle and are known as midsize employers.
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Unlike other countries around the world, the United States does not regulate or negotiate drug prices. In general, the European Union members (eg, United Kingdom, France, Germany), Australia, and other countries incorporate pricing at the time of new drug approval, and allow the use of a new drug when it provides a significant clinical benefit over existing drugs, relative to the drug price.
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The 2016 American Society of Hematology (ASH) meeting provided insight into new treatment options and mechanism of action choices for hematologic cancers. Health plans need to continue to expand their knowledge and expertise in all cancer types to maintain the ability to manage and apply coverage criteria appropriately as FDA approvals continue to increase in oncology.
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Washington, DC—Employers recognize that oncology care is expensive, and they are shifting their focus on cost management. As such, employers are seeking approaches to determine which drugs and health plan designs will help them manage pharmacy and medical costs to improve patient outcomes, said F. Randy Vogenberg, PhD, RPh, Partner, Access Market Intelligence, and National Institute of Collaborative Healthcare, Greenville, SC, at the Sixth Annual Conference of the Association for Value-Based Cancer Care.
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In today’s changing oncology landscape, the quality and value of cancer care have become increasingly integrated. With the rising costs of cancer treatment, payers and policymakers aim to better define value, as well as to educate patients about their therapeutic options. Insurers and payers have implemented a variety of strategies to control costs at the behest of employer plan sponsors, including utilizing oncology clinical pathways.
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Many significant and interesting topics highlighted at ASCO 2016 are discussed in this publication, covering clinical, safety, and economic issues related to cancer therapies.
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“Value” in healthcare has been defined as outcomes relative to cost. Determining the value of a healthcare benefit remains difficult and complex for many stakeholders. With the increasing cost of cancer therapies, value has become an important topic of conversation for patients, healthcare providers, self-funded plan sponsors (employers), and payers.
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