Interviews

Robert Galvin, MD, CEO, Equity Healthcare, The BlackStone Group, says that as a primary care physician he has a bias that the patient-centered medical home is a great model, but it is very difficult to implement.

Gail Wilensky, PhD, senior fellow, Project Hope, says that larger payers are introducing plans that reward consumers for choosing high-quality healthcare clinicians with lower co-payments and premiums. Dr Wilensky also says that there are many attempts to slow spending and improve quality.

Ross M. Miller, MD, MPH, Medical Executive, Cerner Corporation, says the advantages of health and care benefits for employees span across several areas.

Jacque Sokolov, MD, President, CEO, SSB Solutions, says that in order for clinically integrated organizations to drive revenue the clinical and business models must be coordinated, so incentives exist for revenue enhancement and expense control.

In this video, Aaron McKethan, PhD, Vice President, Strategy and Business Development, RxAnte, talks about new strategies to improve patient medication adherence.

Karen Ignagni, President and Chief Executive Officer, AHIP, says that we need to move from paying hospitals and clinicians based on volume to the value of services provided. In this video, Ms. Ignagni addresses the need to change the way payment is designed and delivered.

Brian Carlin, MD, FCCP, Allegheny General Hospital, discusses the challenges in reducing 30-day readmission rates, specifically as they apply to congestive heart failure, pneumonia, and COPD. The biggest challenge of all is setting up a coordinated team care effort, says Dr Carlin.

In this video, Mark Zitter, MBA, talks about the implications of Co-Pay Offset Programs for managed care. "Co-pay programs affect managed care very differently depending on the nature of the program," says Zitter. "These programs are tremendously varied."

In this video, Barbara Troupin, MD, MBA, talks about managing goals for obesity treatment. "The goal for obesity treatment is the ability to lose enough weight [to the point where] you actually are addressing the underlying pathophysiology," says Dr Troupin. She goes on to discuss the ideal percentage of weight loss necessary to lose excess adipose tissue.

In this video, Aimee Tharaldson, PharmD, discusses some of the current trends in the specialty pharmacy market. In addition, Dr. Tharaldson specifically comments on the oncology pipeline, which currently has the most activity.

In this video, Marcus Wilson, MD, President, HealthCore, talks about the important relationship between electronic medical record data and claims data.

Robert Berenson, MD, FACP, Institue Fellow, Health Policy Center, Urban Institute, states that the development of new care delivery models will not happen overnight. There is time before expectations are put into specific quality metrics and regulations for models such as patient-centered medical homes and accountable care organizations.

Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy and Founding Chair, Department of Health Policy, George Washington University School of Public Health and Health Services, says that the purpose of health reform was to provide people a source of affordable coverage so everyone would be attached to a payment system.

Peter Cunningham, PhD, Senior Fellow and Director of Quantitative Research, Center for Studying Health System Change, says that the expansion of people gaining coverage will be a big challenge for primary care delivery systems.

Robert Galvin, MD, CEO, Equity Healthcare, The BlackStone Group, states that bundling is a payment reform model that will allow for high quality and lowered costs.

Juliette Cubanski, PhD, Associate Director, Program on Medicare Policy, Kaiser Family Foundation, believes that the Medicare program overall has as much at stake in the 2012 election. Specifically, Dr. Cubanski says increasing private plan participation in Medicare and whether Medicare should move towards privatization will be some of the greatest challenges moving forward.

Karen Ignagni, President and Chief Executive Officer, AHIP, feels Medicare is right to take on the challenge of hospital readmissions. Ms. Ignagni also discusses how the Medicare Advantage plans have done a better job with traditional fee-for-services programs and tackling high hospital readmission rates.

Robert Berenson, MD, FACP, Institute Fellow, Health Policy Center, Urban Institute, thinks that new healthcare delivery models are inevitable due to the behavior of physicians and providers who have abused fee-for-service. Dr. Berenson says that there has been unacceptable growth in the bias of fee-for-service activities, and new delivery models are necessary to improve quality and costs in healthcare.

In this video, Aimee Tharaldson, PharmD, Senior Clinical Consultant, Emerging Therapeutics at Express Scripts, Inc, says that the increasing of specialty medication approvals impacts both patients and payers.

Mark Zitter, MBA, CEO of the Zitter Group, states that oncology pathways can standardize the way care is delivered while improving quality and reducing costs.

Debbie Stern, RPh, Vice President, Rxperts Inc, states that the utilization of prior authorizations, developing pathways, and relationships with specialty pharmacies all assist in the management of specialty pharmaceuticals.

Jeff Lemieux, Senior Vice President, Center for Health Policy and Research, AHIP, and Jon Bumbaugh, Director of Statistics & Actuarial Services, MedAssurant, Inc, address preventing hospital readmissions.

In this video, David Nau, PhD, RPh, CPHQ, Senior Director, Quality Strategies, Pharmacy Quality Alliance (PQA), speaks about the Electronic Quality Improvement Platform for Plans and Pharmacies (E-QuIPP). E-QuIPP will allow health plans and pharmacies to improve adherence and performance measurement.

Beckie Fenrick, PharmD, MDA, Senior Director, Medical Operations, Care Models and Affordability Solutions, Florida Blue, says that the trending increase in companion diagnostics allows for more personalized medicine.

Keith Dunleavy, MD, President and CEO, Inovalon, discusses the importance of comparative effectiveness research in order to improve chronic disease management at both the individual and population levels.

Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, discusses the use of payment reform models to reduce hospital readmissions.

Sarah Thomas, Vice President, Public Policy and Communications, NCQA, says that this year the NCQA has a targeted interest in health insurance exchanges and delivery system reforms, such as accountable care organizations and patient-centered medical homes.

Robert Margolis, MD, Managing Partner and CEO, HealthCare Partners, says there needs to be a movement toward managing patients based on population.

Keith Dunleavy, MD, President and CEO, Inovalon, addresses the importance of healthcare data and the digitization of medicine. Dr. Dunleavy states that having quality data allows for more accurate care on an individual level, along with cost savings and a better risk score.

Barry Kinzbrunner, MD, Executive Vice President, Chief Medical Officer, VITAS Corporation, speaks about ways for managed care organizations to reduce hospital readmissions.