Panel Discussion: Weighing the Value of Novel Treatment in Diabetes

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Dennis P. Scanlon, PhD, faculty member and health services researcher at Penn State University, associate editor of The American Journal of Managed Care, moderates a discussion regarding the idea of value as it pertains to the emerging treatments and approaches for diabetes care. He is joined by panelists David Brumley, MD, MBA; Edmund J. Pezalla, MD, MPH; and Michael S. Sherman, MD, MBA, MS.

Dr Brumley believes that there are numerous perspectives on the value spectrum—medical claims perspective, clinical perspective, productivity and quality of life values—that need to be assimilated in order to better understand value itself. He adds that examining every angle creates a more holistic picture when dissecting the concept of value.

“Probably the most important thing about the idea of value-based contracting is it makes us think about what it is we actually want to achieve,” Dr Pezalla said. “It asks the question, ‘Are we trying to achieve certain outcomes? Do we want to get there by acquiring people to do things that we think are processes that lead people to those outcomes?’ And then measure those outcomes with sorts of quality measurements.”

Dr Sherman and the panelists discuss patient outcomes in proportion to the “healthcare dollar” as he likes to call it. For patients who for example need a hip repair, the episode and outcome is fairly quite simple. However, the outcomes for patients battling chronic diseases like diabetes are not always black and white. Over longer periods of time, the effectiveness of medications and other treatments needs to be considered when evaluating outcomes for individual patients.

“Where this gets interesting in something other than an academic discussion, is when health plans like ours put in place payment frameworks that actually pay for value,” Dr Sherman said.

The panelists additionally discuss the importance of benefit designs in an era of high deductible health plans where patients are unable to access treatment or medications of value—cost often influences the patient’s choices of treatment options. Dr Scanlon also asks the panelists to consider patient reported outcome measuring tools, the revolution of technologies that help in the exchange of information, and the value of new care delivery models that healthcare stakeholders are proposing.