Panel Discussion

Dr Ribas opened this segment by discussing the new immunotherapy agents used in the treatment of metastatic melanoma. Specifically, he discussed the agents vemurafenib (Zelboraf), dabrafenib (Taflinar), and trametinib (Mekinist).

Panel moderator and AJMC co-editor-in-chief Dr Mark Fendrick introduced panelists Jennifer Malin, MD, PhD, manager and medical director of oncology, WellPoint; Jeffrey Weber, MD, PhD, senior member, H. Lee Moffitt Cancer Center Director, Donald A. Adam Comprehensive Melanoma Research Center; and Antoni Ribas, MD, PhD, Jonsson Comprehensive Cancer Center, UCLA.

In the final segment, panelists examine the use of companion diagnostics to determine proper patient utilization. Dr. Chernew asks if the required diagnostic testing is being appropriately used and if they are being covered by payers.

This segment of the panel discussion takes a closer look at the episode of cost for a patient going to a hospital versus a private office setting. Panelists agree that the cost of hospital care is not that much greater than in the office.

Dr. Chernew asks the panelists how payers address the value of these costly combination therapies when there are less expensive options available. Dr. Newcomer says that the drugs being discussed are, in fact, having a significant clinical effect.

In this clip, Dr. Swain and Dr. Newcomer discuss the results from the EMILIA trial. Dr. Swain notes that the survival benefit with the use of TDM-1 was five months.

Moderator and AJMC co-editor-in-chief, Dr. Michael Chernew delivers a brief overview of the discussion. The discussion focuses on the use of trastuzumab emtansine (Kadcyla) and pertuzumab (Perjeta). Panelists address the patient populations for the two agents and identify which are eligible to take the targeted therapy.

Panelists talk about payment reform models, such as accountable care organizations and bundled payments, as a response to new treatments in oncology.

Panel members are asked to discuss what drives the cost of drugs in cancer care. They also discuss the role companion diagnostics and personalized medicine play in oncology.

In this segment, panelists address coverage strategies health plans may utilize to finance patient access to the combination treatment.

AJMC's Co-Editor-in-Chief, Michael E. Chernew, PhD, Lee N. Newcomer, MD, MHA, UnitedHealthcare, and Sandra M. Swain, MD, Washington Cancer Institute, Medstar Washington Hospital Center.

Panelists address the need to solve the SGR problem by using innovative payment systems.

Paul Ginsburg points out both positive and negative aspects of the SGR.

The panel addresses various payment and delivery system changes in the long run that are more likely to be successful.

In this segment the panel talks about the consequences SGR might have on primary care practices. They discuss what the efficient costs of production are for the healthcare we aim to deliver.

Panelists ask what are possible solutions to fix the SGR in the short and long-run.

Panelists agree that congress does not want these cuts in physician payment rates and Medicare.

The panel members discuss the question of how much would it cost to abolish the SGR.

Panel members discuss the fundamental problems with the SGR formula.

Panel moderator, Dr. Michael Chernew addresses this panel's topic, the sustainable growth rate (SGR) formula. Panel member, Paul Ginsburg, gives a brief overview of the SGR formula.

Dr. Chernew summarizes key points of the discussion and asks members to add any additional information.

Panel members talk about whether or not accountable care organizations push organizations to invest in the PCMH and how ACOs will affect the PCMH. Dr. Chernew asks what the impact of PCMH will have on specialists and other healthcare services.

Dr. Chernew asks if in the future, will there be more PCMH, or will more practices have more elements of the PCMH. Dr. Fendrick discusses if many primary care practices will attempt to meet the specific criteria.

Dr. Fendrick asks the panelists to address selection bias in the PCMH model of early adopters.

The panelists discuss whether or not a medical home could have success with a without changing an organization's financial system. Panelists discuss how PCMH fit into the accountable care organization structure.

Dr. Chernew asks if organizations that are recognized as a PCMH receive any rewards for such a title. Panelists discuss the difference in motivation between early and later adapters of the PCMH.

Dr. Sennett discusses what motivates practices to seek recognition as a medical home, and why they attempt to become a PCMH.

Panel members discuss the standards and regulations set for facilities to be considered a PCMH. Dr. Pawlson talks about the standards developed by the NCQA and what they mean.

In this segment, panelists discuss how health information technology contributes to the success of PCMH. Dr. Choudhry says that HIT is necessary for providers to make decisions and track the care of populations in a PCMH.

Moderator, Dr. Chernew, begins this discussion by asking the panelists what a PCMH actually is and when they were developed. Dr. Ginsburg touches upon the structural aspects of the PCMH and how physicians are paid through this model.