AJMCtv® Interviews, June 2017

Allison Silvers on Payment Model Flexibility in Palliative Care

Fee-for-service payment models have not been successful in the field of palliative care, where small practices seem to work better under flexible programs like per member per month, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

What are some payment models that have successfully increased access to palliative care?

What we’ve found is that the fee-for-service model clearly does not work for palliative care. Too much time is needed by the professionals, and there are all the “unbillable” professionals. The payment model that seems to give the most flexibility is per member per month, especially for home-based palliative care where the program is taking care of a specific population. The problem with other models such as fee-for-service with shared savings is that the shared savings are too remote and several programs are small and unwilling to take risk. So just having enough of a flexible pot of money seems to work best.

How have your experiences with community health shaped your work with the Center to Advance Palliative Care?

I spent many years running a senior information center where older adults in need would just come in, it was a storefront, and they would need help with housing or social services or finding good care. It was a really good flavor of people not knowing what their options are, and I think that same thing is true for palliative care. Obviously, there’s a lot of emotional turmoil associated with getting diagnoses, and your doctor then informs you of what they recommend.

Typically, there’s a whole menu of treatment options, and that’s not adequately communicated, and there’s also a lot of other needs that you have that wouldn’t even be addressed with treatment: spiritual needs, family reconciliation needs, etc. I think that idea of giving people options and helping them think through their options is what’s common.

Daniel J. Klein Outlines Patient Routes to Accessing Costly Medications

According to Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation, patients now have an easier time accessing the high-cost treatments they need, thanks to certain policies and programs. Klein also anticipates that a recently enacted law will bring down the prices of some prescription drugs.

What are the major ways patients can get access to costly medications?

Today, most patients do have some form of health insurance, which is great. Usually, there’s coverage available for even high-cost medications through the various health insurance plans that patients have. Where it becomes challenging is when the health insurance plan may have a high deductible, or copay, or coinsurance, and in that case, some patients need additional assistance.

Many patients rely on assistance from the drug manufacturer in the form of a coupon or a co-pay card. Then, patients, particularly in Medicare and other federal insurance programs, may need to come to a charitable assistance program, like the PAN Foundation. But, by and large, as a result of the Affordable Care Act and the expansion of Medicaid, most people do have access to the treatment that they need.

What impact do you expect the 21st Century Cures Act to have on improving access to medications?

Clearly, the process for approving generic drugs has been slower than most people would like. The high cost of some drugs may be reduced through competition through generics, so I think that there’s every reason to hope that the 21st Century Cures Act will improve affordability of at least some medications, and in turn improve access.

The Samfund Expands Its Scope With Financial Literacy Initiatives, Says Samantha Watson

The Samfund is primarily known for its grant funding programs that help young adults struggling financially after having cancer, but founder and CEO Samantha Watson discussed how the organization has expanded into providing financial literacy education and other tools to support the community of cancer patients.

What are some of The Samfund’s initiatives to support young adults who are struggling financially due to cancer?

At the Samfund, our biggest program has always been a grants program. We’ve awarded just over $1.7 million in grants over the last decade. A lot of what we fund is basic everyday stuff, so we provide some help with medical bills and copays and things like that, but we also help with rent and mortgage. We help with insurance premiums, and we help with car payments, and we help with anything that becomes a hardship because someone has gone through cancer at a young age.

But we have also started to focus on financial education, on encouraging some of these conversations, and on helping to improve communication around finances. We have launched a program called Finances 101: A Toolkit for Young Adults with Cancer, which is an online decision-making guide.

The first topic that we covered, right at the time when open enrollment started, was around choosing a health insurance plan, because what we see in our grants program, for example, is that young adults are on their own for insurance for the first time. The marketplace is confusing, and they only have enough, they think, to cover the cheapest monthly plan. So, they get the cheapest monthly plan and then they can’t see their doctors because the plan doesn’t cover them, or they’re going bankrupt because their deductible was way higher than they realized.

We created this guide to help them figure out how to calculate the full cost of insurance for the year, how to compare plans, what their options are, when their marketplace opens, and how to navigate the site. It’s meant not to give directive advice about which plan they should pick, but to put them back in the driver’s seat when it comes to being informed and picking the best plan for them.

From there, we’re going to build out to other topics and really explore this world of financial education and financial literacy, because we think, our hunch after the thousands upon thousands of applications that we’ve read over the years, that a lot of these financial crises can be prevented if people have better information and guidance along the way, and especially at those critical decision-making points. If they’re armed with information, then hopefully they won’t panic, and hopefully they won’t make a decision that’s going to affect them negatively in the long run.

It also opens up the community that we’re able to support, because for years we’ve focused on young adults once they’re finished with treatment. For the toolkit and for our webinar series which also provides a similar type of guidance and support, we don’t care how old someone is if they access it. We don’t care what their treatment status is. We don’t have to care about any of that. We can put the information out and hope that it’s helpful. It really also, again, opens up the type of support that we provide and the size of the community that we’re able to support.

Download PDF: AJMCtv^® Interviews, June 2017