Affordable Care Act

‘DrugAbacus’, a Comparative Cancer Drug Pricing Platform Powered by Real Endpoints’ RxScorecard™, is Launched

Posted on Friday, June 19, 2015

Westport, CT, June 19, 2015 – Real Endpoints (RE) is pleased to announce that its RxScorecard™ is the information technology platform supporting Memorial Sloan Kettering Cancer Center’s DrugAbacus – an interactive tool for considering the basis of cancer drug prices. Conceived by Dr. Peter B. Bach, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering (MSK), DrugAbacus was launched at MSK’s DrugAbacus generates a dollar-value for cancer drugs available in the United States (beginning in 2001 with Gleevec) based on a user’s settings for six different domains of potential value including the treatment’s survival benefit, side effects, and the incidence of the condition targeted. Memorial Sloan Kettering licensed the Real Endpoints RxScorecard platform for research purposes so users can generate “Abacus prices” and compare them with actual prices of these drugs at the time of launch in a visual and intuitive format. “We believe RxScorecard is the only tool available that provides a 360 degree comparison of the multiple components of a drug’s value in an independent, objective and systematic approach. We developed the IT platform to make it very easy for users to access our analysis, and are delighted that Dr. Bach selected this platform for DrugAbacus,” said Julie Eskay Eagle, RE’s Vice...

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UnitedHealth-Mayo: More Data, More Open. But Not Quite Neutral

Posted on Tuesday, January 22, 2013

UnitedHealth’s outcomes-focused research alliance with Mayo Clinic, announced Jan. 15, reminds us of big data’s central role in creating a value-driven US health care system.  The tie-up claims to have created the biggest-yet trove of claims-plus-clinical patient records in the US, combining over 100 million claims records from United’s Optum’s health services division with over 5 million clinical records from Mayo. As such, it’s powerful. Collating top-level insurance claims with in-depth clinical reports is as good as it gets right now for real-world-evidence hunters; it paints the most complete picture of patients’ disease progression that’s available large scale. That’s why payers and drug firms that have already teamed up in the quest for RWE are striving to bring providers into the fold. (You can hear more about AstraZeneca and partner HealthCore‘s efforts to build a consortium at the Real Endpoints’ Symposium on March 11-12.) Optum and Mayo are likewise inviting other organisations to contribute to, and fish in, this pool of longitudinal data: the alliance takes the physical form of Optum Labs, an ‘open innovation facility’ where players – including drug firms, payers, providers, academics – can, with further resources and questions of their own, “come together to conduct research, innovate and improve outcomes for patients,” said Andy Slavitt, Optum’s group...

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The Healthcare Round-up: July 30-Aug 3

Posted on Friday, August 3, 2012

Competition’s the theme for this week’s round-up, brought to you from Olympic city, London. While the world’s best and fastest athletes battle it out for gold (checked periodically for performance-enhancing drugs by our friends at GSK), so the competition’s hotting up among health insurers and providers, too — at least if (some) politicians get their way. The goal: ultra-efficient, cost-effective medical care. In Europe’s engine-economy, Germany (current Olympic medal-count: 18) the government’s pushing for more competition among the statutory health insurers, which are currently enjoying a surplus. As we reported earlier this week, more transparent pricing (and thus more consumer switching) has already sharpened up the country’s 150 or so SHIs. Tighter anti-monopoly laws could lead to an almost US-style free market — with both payers and pharma under pressure to deliver cost-effective solutions. Not that the health care system in the US (current medal count: 37) is a great example of market-competition-driven efficiency. If it were, it wouldn’t be facing lawsuits like that against Blue Cross and Blue Shield in Alabama, accused of conspiring with other Blues plans to avoid competition, thus driving up costs. This kind of behaviour — plus underlying structural issues — is why the US system is rapidly becoming unsustainable. That was the common message...

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The Healthcare Round-up: July 20-27

Posted on Friday, July 27, 2012

Might Ultra-Orphans Enjoy An Easier Passage Past NICE? Perhaps. After much back-and-forth, it seems our old friend NICE will, starting in 2013, assess the cost-effectiveness of high-cost drugs for patients suffering from ultra-rare diseases (affecting fewer than 500 patients across England). These kinds of products, increasingly popular with drug firms, generally struggle to meet NICE’s general evidence requirements (given the difficulty of data collection). Thus, in the past, the agency has considered – and approved – very few. Why might things be easier now? Well, because of the road taken to get here: persistent patient (and industry) lobbying earlier this year gave rise to a newly-created Advisory Group For National Specialised Services (AGNSS), a committee set up to advise the government on which specialized services and technologies should be provided via the National Health Service. But just months on, it seems they’ve recognized that NICE is where the HTA expertise lies, so the buck’s passed back. Except that these ultra-orphan drugs won’t go through the standard NICE process; instead, NICE will develop a new “impartial and robust” mechanism for providing independent recommendations on which drugs should be commissioned nationally. Thus, it won’t be all about the £30,000 cost-per-QALY threshold. In a press release, health minister Lord Howe noted NICE...

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The RE Healthcare Round-Up

Posted on Friday, July 20, 2012

Real Endpoints’ Weekly Healthcare Round-Up has returned. Cue Carol Anne of the ’86 cult flick Poltergeist II – or, if you prefer, the infamous, avenging nerd Lewis (Revenge of the Nerds II) or the exuberant but dorky Stu Price (The Hangover). Feel free to mock our retro-culture cool, but don’t doubt our enthusiasm…or the importance of synthesis. In the six weeks since our last Round-Up, we’ve seen the approval of Qsymia and Belviq, two new obesity drugs that, thanks to their regulatory delays, now face a much bleaker reimbursement climate; WellPoint’s decision to purchase Amerigroup for a 43% premium to gain dominance in the so-called dual eligible population; and, oh yes, a 5-4 vote by the Supremes to uphold most of Obama’s landmark healthcare plan. As pundits continue to unpack the ramifications associated with the healthcare law, the hot-button issue now is how the constitutionally de-clawed portion of the law, Medicaid expansion, will unfurl. Already several governors, especially Texas’s Perry have spoken out about the downsides of Medicaid expansion, raising the specter of financial ruin.  Maine’s governor Paul LePage plans to go a step further, announcing the recent Supreme Court ruling provides him the power to cut thousands of Mainers from the state Medicaid rolls. Much of the US...

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The Healthcare Round-Up: May 27 – June 1

Posted on Saturday, June 2, 2012

Pick up your jumbo pack of toilet paper –and health insurance too. What started as a quiet partnership between club warehouse wholesaler Costco and insurance giant Aetna has now expanded to include relationships in nine states with two more pending approval.  Two years ago, the two joined forces to provide Costco Personal Health Insurance, a health insurance program that offers consumers five options in terms of medical and dental coverage.  Costco sees the tie-up as a means of both diversifying into new product areas and providing “value” to customers via access to a provider network of more than 500,000 primary care and specialty physicians, discounted pharmacy drugs, and online wellness tools and programs. (The other big box store making serious noise about moving into healthcare is Walmart.) For Aetna, the expansion of the partnership shows its commitment to the so-called retail insurance market. One of the underpinnings of the Affordable Care Act is the individual mandate and creation of health insurance exchanges to provide consumers with medical benefits outside the confines of traditional employer-sponsored insurance. Many insurers believe that their future growth depends on enrollment in these exchanges; Aetna has been among the most aggressive in inking alliances or mergers that allow improved benefit designs for exchange users. And...

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The Healthcare Round-Up: May 19-26

Posted on Sunday, May 27, 2012

Real Endpoints would like to congratulate our intern, Halleh Balch, on her graduation from Swarthmore College. We expect great things from Halleh in the years to come; she is one to watch! PSA: To test – or not to test. The big news this week was the United States Preventative Services Task Force’s decision to downgrade the necessity prostate-specific antigen test. After reviewing two large studies, the task force’s working group decided the PSA test, which is designed to flag prostate cancers early, does more harm than good, leading to overdiagnosis and increased treatment risks rather than improved outcomes. According to the USPSTF’s findings, between 1986 and 2005 an estimated one million men received surgery, radiation therapy or both thanks to findings of the PSA test. Of these, at least 5000 died soon after surgery and between 10,000 and 70,000 had serious complications, while another 200,000 to 300,000 suffered impotence. And while the task force is officially recommending against the test, the group seems to have learned something from the mammogram debacle. If patients and doctors feel the test is necessary, it should be performed, as long as there is an “informed “ discussion about the possible benefits and harms. Many, including Matt Farber, the director of the economics and...

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Are We Really That Different? Transatlantic Lessons In Shopping For Value

Posted on Monday, May 21, 2012

The Americans and the English might think that their health care systems are very different: one, a commercial, private-insurer driven network whose incentives are as mis-aligned as its per-capita spend is high; the other, a state-funded, friendly-yet-inefficient model characterized by rationing. There are plenty of similarities, though. Firstly, the pressures – most obviously, spiraling costs — are the same, whether they’re hitting state-owned or private payers. England’s patchwork of regional, public payers (the Trusts) make local purchasing decisions (and, increasingly, coverage decisions, even though they’re not supposed to.)  That makes them look more like individual US commercial insurers. And like managed care groups or PBMs, most deal directly with drug manufacturers to negotiate local rebates. They have to stay within budget– if not make a profit. The UK may be spared the alphabet soup of MCOs, PBMs and ACOs. But the challenge of coordinating cost-effective care between general practitioners, hospital and home settings remains on both sides of the Atlantic. That’s clear from glancing at the range of initiatives underway in the US and UK to try to address spiraling healthcare costs. They may be called different things, but they’re similar enough to provide reciprocal lessons for both pharma and payers. While various US insurers experiment with cancer pathways,...

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The Healthcare Round-Up: 4/6 – 4/14

Posted on Saturday, April 14, 2012

First ACO’s under Medicare’s Shared Savings Program:  In addition to TEDMED, which this week gathered healthcare luminaries to discuss all things innovative, ACO was the other au courant acronym of the news cycle. Even as debate swirls about the fate of the healthcare reform law, there’s an obvious need to better coordinate healthcare, with ACOs being a topic of rare bipartisan politicking.  Thus, its no surprise that accountable care organizations are alive—and growing rapidly—in numbers. On Tuesday, April 10 the Center for Medicare & Medicaid Services announced 27 healthcare organizations will participate in their Shared Savings program, while another five have signed on as advanced payment ACOs. According to the press release from CMS, the new ACOs will serve an estimated 375,000 patients across 18 states; that means together with the 32 pioneer ACOs, there are now 65 accountable care entities serving more than 1 million Medicare patients. But those numbers could quickly swell; some 150 other groups have applied to participate in the Medicare Shared Savings program starting in July. Moreover, a survey of more than 350 health executives released in the April issue of HealthLeaders finds provider interest in the concept is extremely high, with 39% of individual surveyed planning to implement or join an ACO in...

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The Healthcare Round-Up: 3/28 – 4/4

Posted on Thursday, April 5, 2012

Reducing unnecessary care: On Wednesday April 4, nine physician societies, together with the ABIM Foundation and Consumer Reports, released a list of 45 procedures or tests (5 per specialty) that are overused and adding to soaring healthcare costs as part of a new educational initiative called Choosing Widely. Another 8 specialty boards are preparing lists of relevant tests their members should be more judicious about ordering. Once again it’s a reminder that there’s growing support for the idea that in certain areas of healthcare it’s critical to embrace a “less is more” mentality. Among the tests garnering extra scrutiny: CT scans for chronic sinusitis, dual energy X-ray scans for osteoporosis in women younger than 65, and MRIs to evaluate lower-back pain. But given the grievous nature of cancer, it’s the recommendations by the American Society of Clinical Oncology that could prove most controversial, especially guidance to avoid chemotherapy use in advanced cancer patients who are unlikely to benefit. As Sharon Begley of Reuters reports, ASCO’s recommendations were driven by medical considerations, but, importantly, cost was also a major factor.  The NYT suggests doctors will be more likely to embrace the notion of doing less since the guidelines come directly from physician groups (as opposed to a government sponsored organization...

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