While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations. Providers forego certain revenue for uncertain ‘bonus’ payments. “One flaw is built into many VBP incentive designs: They require participants to forgo revenue for the opportunity to earn just a fraction of it back as shared savings. The math doesn’t work. These VBP contracts ask particip ..read more

Progression-free survival (PFS) is a surrogate endpoint is defined as follows (by ChatGPT): In essence, PFS refers to the length of time during a clinical study or treatment regimen where a patient’s disease doesn’t worsen or progress. For instance, in cancer research, it measures the time from the start of treatment until the cancer shows signs of growth, spread, or relapse. Understanding PFS is vital because it helps clinicians and researchers assess the effectiveness of a treatment in controlling the disease. A longer PFS suggests that the treatment is successfully slowing down the progres ..read more

Medical debt in the U.S. is a major problem. While over 90% of individuals have health insurance, many people are uninsured and even those with insurance may be liable to high deductibles and copayments. A Kaiser Family Foundation (KFF) analysis uses data from Survey of Income and Program Participation (SIPP) and finds that: …20 million people (nearly 1 in 12 adults) owe medical debt…people in the United States owe at least $220 billion in medical debt. Approximately 14 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and about 3 million people (1% of adults) owe medi ..read more

LLM approach expert levels in ophthalmology. Price controls in health care (Argentina) Will bird flu (H5N1) animal pandemic spread to humans? Lex Fridman interview with Mark Cuban (with discussion of Cost Plus Drugs) Spotlight on Medicare’s Chronic Care Management program ..read more

Medicare Advantage (MA) plans have a number of advantages and drawbacks over traditional Medicare (TM) (i.e., fee-for-service). One advantage of MA plans is that cost sharing is often lower. Another benefit is that enrollees may receive additional coverage benefits. One drawback is that enrollee provider choice may be restricted. Fewer provider options may be bad for some patients, but it does lower premiums if the narrow network has lower reimbursement rates (see Dafny et al. 2017). A key empirical question is how restrictive are Medicare Advantage provider networks? This is the question Feym ..read more

Some key trends to watch from some of my colleagues at FTI in their article The Evolution of Healthcare: Trends to Watch in 2024. Commercialization of Healthcare. Over the past decade, private equity’s presence in the healthcare sector has significantly accelerated, with annual deal values soaring from $41.5 billion in 2010 to $119.9 billion in 2019. This rapid increase has drawn increased scrutiny from lawmakers and researchers, particularly concerning inflated pricing, limited competition, and decreased quality of care linked to private equity-backed organizations. Mergers and Acquisitions ..read more

Samsung Bioepis has a Biosimilar Market Report for Q2 2024. Some key highlights: As of April 2024, the FDA has approved a total of 48 biosimilars across 15 unique biological molecules.  Of the 48 approvals, 38 biosimilars have launched in the US market.   In Q2 2024, 3 new biosimilars were approved in the US (Simlandi for Humira (adalimumab); Jubbonti/Wyost for Prolia/Xgeva (denosumab); Tyenne for Actemra (tocilizumab)) Moderate discounts. Overall, biosimilars are leading to lower prices, largely through rebates rather than list price. However, prices fell by 41% within 3 years ..read more

While robust data is preferred when parameterizing economic models, this information is not always available. For instance, it may be unclear the degree to which clinical trial results would translate to the real world. Or, clinical trial results may need to be extrapolated beyond the time period of the trial. Or, there may simply be no data available for certain parameters of interest. In many cases, modelers turn to expert elicitation to help them parameterize the model. In some cases this is done informally (e.g., interviews); in other cases, structured expert elicitation is used (e.g., Del ..read more

I will be speaking on two panels at the upcoming ISPOR 2024 conference in Atlanta, GA. Myfirst panel “Economic Insights Into Nutrition: Unlocking the Value in Chronic Disease Management” on Tuesday, May 7, will discuss the opportunities and challenges of economic evaluation of nutrition interventions and compare economic analysis of nutrition interventions with analysis of pharmaceutical interventions. My second panel, “How Can GRACE and Other Novel Methods Estimate ISPOR Value Flower Components? A User Guide to Generalized Cost Effectiveness Analysis (GCEA)” on Wednesday, May 8th will describ ..read more

Congratulations to Philipp Strack who has won the 2024 John Bates Clark Medal. The John Bates Clark Medal is awarded annually each April to that American economist under the age of forty who is judged to have made the most significant contribution to economic thought and knowledge. The American Economic Association webpage has a nice review of his research. One key area of research is around the economics of information. Strack’s approach to formalizing ideas is beautifully illustrated by his axiomatic work on informational cost functions. Arrow (1985) observed that “there are costs of inform ..read more