Physician practice patterns

‘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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Wall Street Journal publishes article on new cancer pricing tool from Memorial Sloan Kettering using RE’s RxScorecard technology

Posted on Friday, June 19, 2015

June 19, 2015 – Memorial Sloan Kettering Cancer Center, one of the nation’s top cancer hospitals, has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. Please click here to access the article....

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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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Zaltrap: Now the Price is Right

Posted on Friday, November 9, 2012

Power to the payer. Just weeks after a team of Memorial Sloan Kettering Cancer Center physicians criticized the high price tag of Sanofi/Regeneron’s new angiogenesis inhibitor Zaltrap in a New York Times editorial, the manufacturers responded by cutting the drug’s price in half. In a statement sent to media outlets, Sanofi emphasized its decision to reduce Zaltrap’s price tag was rooted in a desire to ensure patient access to the medicine, and cited “market resistance” as the reason for the dramatic turn of events. “We believe that Zaltrap is priced competitively as used in real-world situations. However, we recognize that there was some market resistance to the perceived relative price of Zaltrap in the US,” Sanofi told The Cancer Letter, which was first to break the news about the French pharma’s pricing decision. For now it’s unclear how quickly this price reduction will filter down to the population to whom it matters most: the patients. Peter Bach, one of the Memorial Sloan Kettering physicians who authored the New York Times op-ed noted: “They came and told us yesterday that they are lowering the price. It’s too soon to know if this will alter the reimbursement rate, which is what affects our patients and is our focus.” So how did...

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Shifting Docs’ Incentives May Push Pharma Towards Portfolio Deals

Posted on Tuesday, October 9, 2012

As cost-of-care-focused experiments start — at last — to shift doctors’ incentives away from prescribing the most expensive treatment, there’s opportunity for pharma to offer ‘portfolio’ deals, spanning a range of drugs, and support services, across an entire therapeutic area. At least, that’s the view of Harvard Pilgrim’s CMO Michael Sherman, who is among the handful of payers testing new care delivery models with physician groups. You can hear more from him in this short podcast, and at the Real Endpoints Symposium on Nov. 1-2. One of Harvard Pilgrim’s ‘total-cost-of-care’-focused pilots is around bundled payments for diabetic care. For now, it doesn’t include drugs — but, given their contribution to the budget, Sherman would love it if they did. “The pilots can happen without pharma, but they’d be more powerful with,” he says. Most drug firms aren’t in a hurry to sell their products as part of a bulk-buy approach — not least because of the precedent this may set for individual drug prices. But a few, especially those working in me-too-heavy areas like diabetes, are open to the idea. “Companies with a rich TA-specific portfolio might be able to have a good discussion with payers” about a bundled or “all-you-can-eat”deal, says one pharma market access director. The pharma may...

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Sliding Away From Fee-For-Service: How CareFirst Does It

Posted on Monday, October 8, 2012

There’s been a lot of talk about the pros and cons of the standardization that comes from “Cheesecake Factory” style medicine since Atul Gawande published his thought provoking New Yorker piece. Like it or not, forward-thinking physician practices and payers are already embracing the concept. In oncology, look no further than John Sprandio, president of Consultants in Medical Oncology and Hematology and a pioneer in the oncology patient centered medical home movement, and Winston Wong, AVP and pharmacist at CareFirst BlueCross Blue Shield and one of the earliest payer adopters of cancer clinical pathways. Both gentlemen are vocal about the important role evidence-based guidelines play in ensuring both high quality patient care and better outcomes. But there is another equally important reason why individuals like Sprandio and Wong have embraced clinical pathways. They understand these guidelines are an important first step in moving away from traditional fee-for-service mechanisms that reward docs for prescribing ever more expensive products. It’s a subject they’ll both be speaking about in a few weeks at our annual Real Endpoints Symposium in Philadelphia as part of a panel discussion “Radicalizing Healthcare Payment: Why Fee For Service Will Disappear”. In the case of Wong, he’d be the first to emphasize that fee-for-service reimbursement isn’t going away...

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Risk-Shares Pop Up Again As Payers, Pharma Circle New Payment Models

Posted on Wednesday, October 3, 2012

Say you’re GSK, and a head-to-head trial pitting your drug against the market leader showed non-inferiority. Say, too, that even though you assembled some trial evidence that patients preferred your drug vs. the leader, this hadn’t convinced everyone. So, with 70% of prescriptions still favoring your competitor, what to do? Blunt rebating is one option – but hardly commercially attractive. So how about taking the risk of testing your tolerability claim in the real world? That won’t eliminate the need to rebate (that’s a permanent fixture with me-too drugs) But it may limit it – and, potentially, allow a reduction in the rebate going forward. Here’s how such a contract might work. In exchange for covering drug A, the payer gets discount X. If the drug meets a certain tolerability threshold (defined, of course, relative to the competitor) that discount remains. If it doesn’t, the discount deepens. In the future, if that tolerability data can be turned into reduced overall cost (side-effects, treatment switching costs) the discount may shrink. Impracticable and unlikely to pass muster with payers, you say. Generally speaking, you’d be right. Exhibit number one supporting your conclusion: the paucity of risk-sharing in the US to date. Exhibit number 2: payers’ publicly disclosed reasons for this scarcity,...

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The Healthcare Round-Up: August 3 -19

Posted on Monday, August 20, 2012

The Olympics (and shark week) are over, the dog days have officially arrived, and here at the West Coast branch of Real Endpoints, it’s back to work as the little people head back to school. (Already!) Given Mitt Romney’s choice of Paul Ryan as his running mate, it’s a sure bet healthcare (especially Medicaid and Medicare) will remain a subject of debate in the run-up to the presidential election. So will the subject of “big medicine” and standardization. Atul Gawande’s New Yorker piece on the topic continues to generate discussion in the blogo- and twitter-spheres as well as #longread recommendations. And it’s no wonder. If you’re like me you’ve probably taken for granted (or refused to believe) that a chain like the Cheesecake Factory can provide high quality food and service for a reasonable price. What Gawande does so well is show you the non-obvious steps that CF uses to manage the process and highlight where—and how—such standardization would make a difference in healthcare delivery. Even better are the specific examples he cites, whether it’s Steward Hospital’s tele-ICU service or Brigham and Women’s Hospital’s attempt to standardize joint-replacement surgery. In the latter case, it’s interesting to see how the creation of a dedicated process –for instance, one that requires...

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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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Physician Engagement Is Key To Lowering Oncology Costs: A Conversation With Texas Oncology’s Barry Brooks

Posted on Tuesday, April 24, 2012

“Oncology is unique, but it’s less unique than it used to be.” So said Daniel Mullins, a healthcare economist at the University of Maryland School of Pharmacy, during an opening workshop held April 18 at the Academy of Managed Care Pharmacy’s annual event in San Francisco. Such language is an overt acknowledgement that soaring oncology costs are a collective problem for US payers, many of whom are experimenting with evidence-based initiatives like cancer pathways or novel reimbursement plans for providers (or sometimes both). But before they can leverage pathways and bundled care, payers must open their doors to community oncologists and convince them to collaborate. “We’ve got to engage providers and come up with consensus,” admitted Dr. John Cruickshank, chief medical officer of the New Mexico-based payer Lovelace Health Plan at the AMCP meeting. That’s music to the ears of Dr. Barry Brooks, a medical oncologist with Texas Oncology, a community-based practice affiliated with Innovent’s US Oncology. In a recent 15 minute podcast with Real Endpoints, he offers a provider’s perspective on the engagement issue, as well as simple solutions. Brooks is a big fan of cancer pathways and understands why payers believe the concept is a powerful tool to lower oncology costs. But he predicts providers would embrace...

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