Going Below The Surface E-Newsletter: November 2019
November 20, 2019
The Going Below The Surface (GBTS) Forum – representing patient groups, providers, payers, employers and life science organizations – announced a series of efforts to drive an informed, sustained and action-oriented dialogue addressing U.S. health spending issues. The Forum’s work is designed to raise awareness of and tackle a variety of health spending challenges, starting with key questions on how much and how best to spend on health care. Activities include an initiative to address low-value or unnecessary care, town halls and this monthly e-newsletter.
If your organization is interested in getting involved, let us know — drop us a line or tweet using #GoingBelowTheSurface.
This month we consider whether some seemingly obvious initiatives to improve patient outcomes and lower health care costs actually fulfill their promise through two recent studies: one evaluating the impact of coordinating care and another looking at what happens when free medicines are provided to patients. Their findings prove that we cannot rely on assumptions and instead must ensure we are implementing evidence-driven solutions.
It’s not news that affordability remains a concern for patients. One hypothesis suggests that eliminating out-of-pocket costs for patients could dramatically increase the chance that patients will take prescribed medicines. That premise may be reconsidered in light of a new study from JAMA Internal Medicine that found financial barriers might only play a limited role in medication adherence.
In Ontario, Canada, researchers provided free essential medicines to nearly 800 patients who reported being concerned about medication affordability. After one year, the patients’ adherence rates plateaued at the 38% mark. While that is better than the 26.6% adherence rate in the control group, the results suggest that pricing is not a magic bullet for guaranteeing adherence or outcomes. Ultimately, while providing free medicines resulted in a small increase in medication adherence, a full 62% of patients continued to have difficulty sticking to their medication regimens even when out-of-pocket costs were eliminated.
Why it Matters: Providing free medicine is not a cure-all for patient adherence. The JAMA Internal Medicine study was optimized for success: patients even received their prescriptions by mail, which has also been shown to boost adherence. The findings of this study suggest solutions will need to focus on more than just price; other barriers must be considered. In order to fully address concerns around spending and patient outcomes, stakeholders across the system must continue to understand the role that patient education, patient reminders and social determinants of health play in patient adherence.
Accountable care organizations (ACOs) were created to coordinate care services with the ultimate goal of delivering high-quality care while reducing costs. Preliminary studies on ACOs’ results have shown modest declines in spending for patients and hospitals, but a recent study in the Journal of Clinical Oncology (JCO) found those results may not persist over the long term, at least not in cancer care.
Miranda Lam, a radiation oncologist at Dana-Farber Cancer Institute, and her colleagues compared Medicare claims data from 2011 to 2015 for beneficiaries with a cancer diagnosis at ACO practices with non-ACO practices in the same geographic region. The authors found that the introduction of ACOs had no meaningful effect on spending or utilization for patients diagnosed with 11 different types of cancer.
Why It Matters: The new findings on the inability of ACOs to impact spending for costly diseases illustrate the danger of assuming one cost-saving approach will automatically work across all conditions. Looking hard at possible reasons for a lack of cost savings—the authors of the JCO piece indicate that the difficulty in treating complex diseases, as well as a drive toward value-based care, is impacting ACOs and non-ACOs in similar ways—will be critical in fashioning future care models that can deliver high-quality care for less money.
Why is it so hard to reduce low value care and inject more high-value practices into our health care system? Here are some journal articles that examine the question.
Conversations about health care spending continued this month during regional town halls, podcasts and journal articles.
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