Interviews

The US horizon scanning system is more comprehensive than the one used in Europe, but the US has the disadvantage of having a more fragmented healthcare system, explained Elise Berliner, PhD, director of the Technology Assessment Program in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality.

Julia Adler-Milstein, PhD, was named the first winner of the Seema S. Sonnad Emerging Leader in Managed Care Research Award at the 20th anniversary event for The American Journal of Managed Care, held October 28 in Orlando, Florida. Ashish K. Jha, MD, professor of health policy at the Harvard T.C. Chan School of Public Health, nominated her for the award and explains why he believes she is an Emerging Leader and the importance of this award.

Patients, especially those with complex chronic conditions, factor in a lot of different things when making care decisions, and increasingly cost is a huge issue, said Marc Boutin, JD, chief executive officer of the National Health Council.

As the healthcare industry moves toward population health and improving quality and value, The American Journal of Managed Care (AJMC) is in a good position to help lead the change, according to Rose Maljanian, RN, MBA, chairman and chief executive officer of HealthCAWS and a member of the AJMC editorial board.

Getting health information technology (IT) to work in one provider system can be difficult enough, but in ACOs, they have multiple systems on different platforms, explained Joseph Gifford, MD, chief executive officer of the Providence-Swedish Health Alliance.

Measuring quality of life in oncology care is difficult for a number of reasons, but Laura Long, MD, MPH, president at TheLongView, PC, expects that to change in the future.

The shift to a pay-for-performance environment healthcare gets the provider more involved with the patient, which has a greater impact on quality measures like adherence, said Mitzi Wasik, PharmD, BCPS, director of Pharmacy Medicare Programs at Aetna, Inc.

There has been tremendous momentum in the value-based insurance design movement in the US healthcare industry, but there are 3 specific ones that are noteworthy, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

There are a number of financial hardships patients with cancer can face, even if they are insured, such as loss of employment, depletion of retirement accounts, and bankruptcy, said Veena Shankaran, MD, MS.

There have been many studies proving that depression interferes with medication adherence, but it isn't enough to just treat depression to get better outcomes, providers have to hand hold patients and help them improve their motivation to start taking medications again, explained Paul Ciechanowski, MD, MPH, associate professor at the University of Washington.

One way to make all patients with cancer, regardless of socioeconomic status, feel like they're on the same level when receiving treatment is to ensure they know they're being taken care of, said Mary Lou Smith, MBA, co-founder of the Research Advocacy Network.

The Patient-Centered Oncology Care meeting provides a great opportunity for stakeholders from across healthcare to get together, and when that happens very good things can come from it, according to Peter Bach, MD, MAPP, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes.

There is no such thing as intervention for mental health that is too early-one of the most interesting early interventions Robin Henderson, PsyD, director of behavioral health services and interim director of health integration at St. Charles Health System, has been involved with is in the neonatal intensive care unit.

Although there are innovative ideas from drug manufacturers and pharmacy benefit managers (PBMs) about improving medication adherence, no one wants to get into legal trouble to implement them, said Lauren Harner, JD, senior manager of policy at PhRMA.

Pathways are still a young enterprise so barriers to their adoption are being more readily recognized than the number of problems being solved are, according to Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Managed care will become rapidly refined and driven toward more patient-reported outcomes in the future, said Christine K. Cassel, MD, president and chief executive officer of National Quality Forum.

With new treatments helping patients with cancer to live longer, healthcare providers now have new issues of long-term survivorship to consider, said Joseph Alvarnas, MD, the editor-in-chief of Evidence-Based Oncology.

The digitization of health will help to identify patients when they're most vulnerable and present new opportunities to change the trajectory of their disease before they suffer avoidable consequences associated with chronic disease, said Lonny Reisman, MD.

One of the great aspects of the Medicare Shared Savings Program is that it provides an important opportunity directly to physicians, said Louis Morgenier, chief executive officer of Physicians ACO, LLC.

The American Journal of Managed Care (AJMC) is the first and greatest source of managed care information and research, said Julie Slezak, MS, chief analytics officer at CareCore National and an editorial board member for AJMC.

The use of genetic testing has led to a radical change within certain specialties and hospital departments. And although doctors are being asked to do more, they do it gladly because the work leads to better treatment decisions for patients, said Mark G. Kris, MD, William and Joy Ruane chair in thoracic oncology at Memorial Sloan Kettering Cancer Center.

With the goal of accountable care organizations and population health being patient centric, it is important that stakeholders involved in the care of the patient develop partnerships to deliver high-quality care in a cost-effective manner, explained René Lere, MD, president of Florida Blue and GuideWell.

There are 3 main risks to the sustainability of accountable care organizations and the move to accountable care, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

Although patients are being asked to pay more when it comes to their healthcare, the concept of having more "skin in the game" is misguided when it comes to healthcare, according to Elise Gould, PhD, senior economist and director of health policy research at the Economic Policy Institute.

The healthcare system in the US makes it nearly impossible for patients and physicians to form a real relationship, and patients are rarely asked about what's going on in their lives, which could inform treatment, said Marc Boutin, JD, chief executive officer of the National Health Council.

David Blumenthal, MD, MPP, president of The Commonwealth Fund, believes that managed care has lost some of its focus and he would like to see more attention paid to holistic management of care for the frailest, sickest patients.

Palliative care should enter into the discussion with patients with cancer as early as possible as it can manage symptoms from therapy or it can provide comfort to patients who cannot afford or choose to forgo therapy, said Amy Davidoff, PhD, MS. Plus, she discusses the impact biosimilars may have on therapy costs.

Although CMS has introduced a strict timeline to move to value-based payments, its new Oncology Care Model is partially relying on fee-for-service, and that's a good thing in the case of oncology, said Ira Klein, MD, MBA, senior director of quality, Strategic Customer Group at The Janssen Pharmaceutical Companies of Johnson & Johnson.

The earlier you intervene with patients with mental health issues, the better the outcome for both the individual and the health system. Early intervention prevents pain and suffering and actually saves costs in the long run, said John Santopietro, MD, chief clinical officer of behavioral health at Carolinas HealthCare System.

One of the biggest challenges with measuring primary medication nonadherence is coming up with a definition for it in the first place.