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This Week in Health Care Reform: October 26th, 2018

A growing proportion of health care payments are found to be tied to value; drug price transparency fails to address patent manipulation; American workers are increasingly burdened by health care costs; and, telehealth holds promise for improved chronic pain management.

Week in Review

Value-Based Care: The movement towards value-based care continues to reshape the contours of our larger health care delivery model.  From how patients choose a provider to how those providers are subsequently reimbursed, it seems that no aspect of the health care transaction has been left untouched by this evolution.  As it relates to reimbursement design, new data suggests that that transition is only gaining steam.  According to a recent report from the Health Care Payment Learning and Action Network, 34 percent of health care payments in this country – representing 226 million Americans and nearly 80 percent of the nation’s covered populations – are now tied to value-based care.  While slightly below the 41 percent still based on volume and not linked to quality and efficiency, it still represents a not insignificant uptick from the 23 percent of payments tied to value measured two short years ago.

Rx Price Transparency: A new analysis brings into sharp focus just how dramatically the pharmaceutical industry has come to rely on price hikes.  Put simply, 61 percent of the 28 percent growth in sales for 45 of the biggest-selling drugs in this country over the past three years is a result of price increases.  That roughly translates to $14.3 billion of the $23.3 billion in sales growth for those medicines between 2014 and 2017.  Against that backdrop it’s not hard to imagine why so many stakeholders point to transparency in drug pricing as being such an important part of what needs to be done to rein in these unsustainable costs.  However, there’s a growing sense that any steps taken towards greater transparency would be rendered ineffective without also acknowledging what’s quietly become drug manufacturers’ ace-in-the-hole – namely, the patent gamesmanship that so many of these companies deploy as a matter of routine to manipulate and maintain monopolistic control over their best-selling drugs.

Worker Costs: As health care costs have climbed in recent years, American workers are being asked to shoulder an increasingly larger portion of those costs.  In fact, the cost of health coverage for people obtaining insurance through their employer rose 5 percent this year, which has the ancillary effect of placing sustained downward pressure on wages and income.  When seeking to explain what may be accounting for this rapid growth in health care costs, a growing chorus of experts point to rising prices – for physicians, drugs, and medical procedures – as the culprit; a sentiment that’s also shared by patients, who are increasingly placing blame on hospitals as they find themselves exposed to surprise medical bills

Telehealth & Chronic Pain:
According to a recent report from the Centers for Disease Control and Prevention, as many as 20 million Americans live with debilitating chronic pain.  In addition to the estimated $560 billion in associated costs from medical expenses, lost productivity, and disability programs, those struggling to cope with chronic pain are also vulnerable to restrictions in mobility and daily activities, opioid dependence, depression, anxiety, and a poorer quality of life, the study’s authors go on to point out.  However, as digital technologies continue to improve access and help overcome traditional barriers to care, stakeholders increasingly believe that connected platforms – like those offered through telehealth – can help improve care management for patients with chronic pain.      

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