Interviews

One of the most exciting takeaways from the ACO and Emerging Healthcare Delivery Coalition is the concept that stakeholders in many facets of healthcare are coming together to make a success out of the accountable care organization revolution, said moderator Leonard Fromer, MD.

Funding is an obvious issue facing Medicaid right now, but another is the changing demographic, J. Mario Molina, MD, president and chief executive officer of Molina Healthcare, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

There were a number of reasons why Michigan chose to expand its Medicaid coverage, and economics was just one part the decision, according to Stephen Fitton, Medicaid director at the Michigan Department of Community Health.

The high cost of Gilead Science's hepatitis C drug Sovaldi is causing Medicaid to come up with new ways of handling drug costs, according to Matt Salo, executive director of the National Association of Medicaid Directors.

How a health plan performs in the CMS star ratings to going to have a bigger impact on their finances in the coming years, Snezana Mahon, PharmD, senior director of Medicare solutions at Express Scripts, said.

As the 2014 midterm elections near, healthcare could have an impact on voter decisions and campaign efforts, Avik Roy, senior fellow at the Manhattan Institute, said at the American Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

Health plans, providers, and consumers have to collaborate in order to bring value, Craig Thiele, MD, chief medical officer at CareSource, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

The most recent Medicare Advantage and Part D program audits revealed that oversight of formulary administration is an area that health plans continue to struggle with, Sarah J. Lorance, vice president of Medicare Compliance at WellPoint, said at America's Health Insurance Plans' National Conference on Medicare and Medicaid and Dual Eligibles Summit in Washington, DC.

The move toward an age of digital health will allow doctors to learn more and faster when it comes to drug toxicity and side effects, according to Peter P. Yu, MD, FASCO, 2014-2015 ASCO president.

Genetic and companion testing takes a village, according to Jan Berger, MD, MJ, president and chief executive officer of Health Intelligence Partners and editor-in-chief of The American Journal of Pharmacy Benefits.

Health information technology presents an exciting opportunity for researchers interested in applied work, according to Karen B. DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology.

The only way to manage the massive amount patient data being collected today is by using big data in real time, according Dr Keith Dunleavy, president, CEO, chairman of the board for Inovalon, Inc.

Kimberly Westrich, director for health services research for the National Pharmaceutical Council, explained why accountable care organizations should consider medications an essential part of condition management.

Dr Peter P. Yu, MD, Emphasized the importance of value when considering the implications of cancer care.

Karen B. DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology said the promise and power of health information technology in the world of public health is vast and growing.

Karen Lewis, MS, MM, CGC, medical policy administrator and genetic counselor at Priority Health, said that providers are engaging in genetic testing, but they are doing so in "an uninformed fashion."

Peter Paul Yu, MD, FASCO, who this summer became president of the American Society of Clinical Oncology, shared how the group is leading the discussion of what constitutes value in cancer care, as well as the need to engage all stakeholders in this critical topic.

Karen DeSalvo, MD, National Coordinator for Health Information Technology, said that while patients expect their medical records to be confidential, they are open to information sharing so long as it leads to improvements in their health or the health of others. Moreover, as Dr DeSalvo reveals, many patients expect their medical records to be digitized.

Len Nichols, PhD, director of the Center for Health Policy Research and Ethics (CHPRE) and a professor of Health Policy at George Mason University, describes how medical tourism improves care while lowering costs.

Richard Umdenstock, president and chief executive officer, American Hospital Association, says that many Americans who are newly insured have not had a high level of interaction with the healthcare system. Some people in this patient population might not even know that there are opportunities to engage with members in their community.

Jan Berger, MD, MJ, President & CEO, Health Intelligence Partners, and editor-in-chief of The American Journal of Pharmacy Benefits, explains that next generation sequencing involves gaining a better understanding and deeper knowledge of the subject, not just another "test here or a test there."

Amy Berman, BS, RN, senior program officer at the John A. Hartford Foundation, says that the triple aim promotes better health, better care, and lower costs. All too often, however, current oncology treatment regimens do not achieve the triple aim.

Len Nichols, PhD, director of the Center for Health Policy Research and Ethics (CHPRE) and a professor of Health Policy at George Mason University, says that transparency in healthcare is an important concept.

Dennis Scanlon, PhD, professor of health policy and administration at Penn State University, says that it is important to consider what details patients need in order to make informed decisions. For payers, this might include informing consumers about enrollment decisions.

Farzad Mostashari, MD, CEO, Aledade Inc, former National Coordinator for Health Information Technology, says that the Blue Button Initiative is a concept that allows patients to receive a copy of their own health information and use it however they like.

Comparative effectiveness research (CER) collaborative tools can benefit pharmaceutical companies in a variety of ways.

It is well known that oncology care pathways are the tools that practices can utilize to care for its patients. Ira Klein, MD, MBA, FACP, chief medical officer, National Accounts Clinical Sales & Strategy, Aetna, suggests that Aetna's only involvement in creating these pathways should be in helping these practices develop "reasonable care pathways."

Michael Bousselot, policy advisor, Office of the Governor for the state of Iowa, believes that the Healthiest State Initiative effectively improves the populations' health and wellbeing because it is privately led and publicly endorsed.

Laurel Pickering, MPH, president & CEO of the Northeast Business Group on Health, explains that employers are transitioning employees into consumers with the help of "transparency tools" centered around price and quality.