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This Week in Health Care Reform: August 31st, 2018

The pharmaceutical industry’s exploitation of the patent system comes under harsh scrutiny; Medicaid helps make consumer centricity a reality for patients with complex care needs; an urgent health care need is targeted; and, obstacles remain in the ongoing shift from volume to value.

Week in Review

Rx Patent Abuse: A recent report details how drug manufacturers’ manipulation of the patent system artificially extends their monopolistic pricing power far beyond what the law intends.  Case in point: the best-selling drug on the planet, AbbVie’s Humira, also holds the distinction of having the most patent applications with 247.  Further, on average, the top dozen highest-grossing drugs in this country are protected by 71 patents – which block competition for 38 years.  A separate analysis paints an equally alarming picture of just how pressing the issue of rising drug prices has become.  In looking at the overall health care spend for a commercial New England insurer over a six year span, researchers determined that prescription drugs accounted for one in every four dollars spent by the plan, due, primarily, to the increasing prices of specialty medications.

Medicaid & Consumer Centricity: As more emphasis is placed on finding ways to better empower consumer-patients in the health care decision-making process, there’s corresponding momentum to apply this focus to previously overlooked segments of that population, for instance, Medicaid beneficiaries, where that approach has started to gain traction as stakeholders slowly integrate greater consumer centricity into how they meet the often complex health care needs of a population made all the more complicated by looming physician shortages, limits in coverage, and a host of other challenges.

According to a recent study, nearly 4 million patients per year miss out on accessing the care they need as a result of a lack of transportation options.  And, with baby boomers hitting the age of 65 at a rate of 10,000 a day, this unmet need threatens to overwhelm an underprepared and already overtaxed health care system.  Further exacerbating the issue is the cost of these missed appointments, which some estimates peg at $150 billion in lost revenue.  It’s hard to deny that this is an escalating problem in need of a comprehensive solution.  With this in mind, a host of companies have looked to fill the gap, partnering with health systems to address the issue.  Other stakeholders, having already identified the criticality of getting their patients from point A to point B and back, are well ahead of the curve, such as CareMore Health Systems, which caters to a Medicare population with complex health needs, and who, two years ago, entered into an innovative partnership with ride-sharing company Lyft to provide rides for their members.

Transition to Value:
Whether owing to its high degree of fragmentation or the general opaqueness that too often obscures clarity in navigating its intricacies, our health care system suffers from an overabundance of inefficiencies that threaten to swallow it whole.  Throw in the complexities of meeting the increasingly complex health care needs of a diverse population, and it’s no wonder so much collective energy is being devoted to figuring out just where we go from here.  An integral component in finding our way to a better way of doing things is the exigent transition away from volume-based, fee-for-service care and towards a better aligned, value-based care reimbursement model.  To be sure, though, that’s not without its own challenges, such as outdated regulations that were codified to meet the needs of a health care system that no longer aligns with where we need it to go.  And, persistent obstacles to care coordination continue to complicate the ability of insurers, providers, and drug and device manufacturers to engage in the kind of value-based contracts that translate into real cost savings for everyone.      

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