Last week, I had the distinct privilege of presenting the keynote at the first annual Northeast Regional Conference of the Association of Healthcare Value Analysis Professionals (AHVAP). With the ever-increasing push away from fee-for-service and toward value-based healthcare, I thought it pertinent to discuss the role of value analysis in the success of a health system’s bundled payment initiatives. Specifically, I wanted to highlight the role evidence can play in assisting value analysis professionals in their evidence-based decision making, as well as how it can help them define the part they play in the value-based purchasing environment.
In early March, Becker’s Hospital Review reported that MD Anderson Cancer Center placed their Oncology Expert Advisor project on hold. Announced in 2013, the joint effort between the hospital and the software giant was to be a revolutionary step forward in the use of “big data” to significantly improve clinical decision making and healthcare delivery. The article cites a number of reasons as to why the initiative was sidelined, not the least of which was cost. However, according to the article, a far more interesting complication arose involving MD Anderson’s electronic health record (EHR) system, which was changed after the program had begun. IBM Watson’s technology no longer communicated with the new EHR system and therefore had outdated information.
Traditional cancer treatments include procedures with which we’re all familiar: chemotherapy, surgery, and radiation therapy. But clinicians and scientists continue to work tirelessly to find a cure for the devastating disease. While immunotherapy has been in the news as of late as relates to the treatment of peanut allergies (see our blog, Peanut Allergy Drug Therapies Make National Headlines), there have been advances in its use for the treatment of cancer over the past few years. There are several biologic agents that are FDA approved for different cancers; these targeted therapies are aimed at destroying cancer cells without the troublesome side effects that accompany traditional cancer treatments.
But there’s something new on the horizon from the world of immunotherapy.
America has an opioid problem.
According to a 2016 report from the American Society of Addiction Medicine (ASAM), drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015. Of that number, 20,101 overdose deaths were related to prescription opioid pain relievers and 12,990 overdose deaths were related to heroin in 2015. In 2012, 259 million prescriptions were written for opioids; 80% of new heroin users began by misusing prescription painkillers.
This week, we were fortunate enough to have a conversation with Dr. Nierman of Tufts Health Plan, located in Watertown, MA. The Tufts Health Plan is a nonprofit organization, founded in 1979, that is nationally recognized for its commitment to providing innovative, high-quality healthcare coverage. The plan offers members and employers an array of health management programs, which support evidence-based approaches to health and wellness. Dr. Nierman has served as the Medical Director for Medical Policy for more than 18 years, and took the time to speak with us regarding why the plan made the decision to subscribe to Hayes for our unbiased evidence evaluations to better serve their health plan members.
Spinal muscular atrophy (SMA) is a genetic disorder characterized by loss of motor neurons, leading to weakness and wasting of muscles used for activities such as crawling, walking, sitting up, and controlling head movement. In severe cases of SMA, the muscles used for breathing and swallowing are affected. This devastating disorder affects approximately 1 in 10,000 births and is the most common genetic cause of infant mortality. SMA is caused by deletions or mutations in a gene that leads to a deficiency of survival motor neuron (SMN) protein; this protein is critical for the maintenance of motor neurons. The severity of SMA is directly related to the amount of SMN protein.
The Neptune Waste Management Systems are used in operating room (OR) suites and surgical facilities to collect and dispose of surgical fluid waste. Some models also remove smoke generated at surgical sites by electrocautery or laser devices. In 2012, the manufacturer of these systems issued a voluntary class I recall. The Food and Drug Administration (FDA) defines class I recalls as those issued in situations in which there is a reasonable probability that the use of or exposure to a product will cause serious adverse health consequences or death.
Documented evidence of the use of honey for medicinal purposes has existed for centuries across continents and cultures. As is so often the case, what’s old is new again, and honey has seen a resurgence as a treatment, specifically as a topical ointment to aid in wound healing. Because of its antimicrobial properties, honey is often used when treatment with antibiotics and antiseptics have failed. The honey produced by the Manuka (species Leptospermum scoparium) flower of New Zealand has been shown to be one of the most powerful in this regard.
As 2016 draws to a close, we here are keeping our eyes fixed on the future for you. Increasingly healthcare-savvy patients want their providers to be up to date on the latest health technology advances, no matter what their stage in the FDA approval process. And while both patients and physicians may want these new drugs, procedures, or devices, payers may be equally unaware of the safety, efficacy, or patient appropriateness of the technologies they’re being asked to cover, particularly when they’re new to market and the peer-reviewed, published evidence is scarce.
With respect to health technologies, the cornerstone of any coverage policy determination requires an understanding of the following:
Does the technology work?
Is it safe?
For whom does it work?