Conference Presentation, Panel, Fireside Chat
If You Cure It, Will They Pay? Placing a Value on Lives
- CF Foundation aims to provide lifelines ensuring patient access to game-changing therapies, with Kalydeco expected to enable full, rich lives for 1,000 US patients at an annual cost of $309,000 for a lifelong two-pill daily regimen.
- Medicare and state budgets are projected to reach fiscal limits regarding escalating healthcare costs due to an inability to pass tax increases, with Medicaid expenses expected to crowd out K-12 education funding.
- Small business owners are anticipated to prioritize cost over quality while out-of-pocket expenses rise without compensating wage growth, driving innovation in medicine to increase rather than decrease unit costs.
- Society is expected to face rationing scenarios where decisions on resource allocation become necessary as the current financial model fails without tax hikes, though direct political decisions on care denial remain unlikely.
- The Affordable Care Act is projected to increase utilization as subsidies distribute, fueling a resurgence in health spending following a recent slowdown.
- Private insurers are expected to intensify focus on value, cost-sharing for drugs and devices, and frameworks for chronic disease management, including care coordination and telemedicine.
- Payers are expected to aggressively seek innovations that lower costs while maintaining outcomes, rewarding cost-reduction strategies and punishing providers who fail to demonstrate performance or efficiency.
- A future adjustment in Hepatitis C treatment volumes is expected as previously untreated patients seek therapy, with untreated disease costs like cirrhosis, liver cancer, and transplants projected to impact the system in 5, 10, and 15 years.
- Future drug development is expected to target currently untreatable diseases, raising unresolved questions regarding societal payment for new costs, while there is concern that aggressive cost-reduction focus on cures may discourage breakthrough therapies for conditions like Alzheimer's.
- Medicare physician payment bills based on value are expected to maintain political consensus due to the difficulty of opposing measures perceived as harming the elderly, while private plans are anticipated to lead government in innovating delivery systems.
- Health plans are expected to partner with delivery systems to reduce conflict by offering incentives like reduced prior authorization to providers adhering to evidence-based guidelines.
- Payers may increasingly require centers of excellence to demonstrate performance or face economic consequences, potentially leading to the closure of rural facilities and a shift toward cheaper, equally effective products.
- Increased scrutiny of outcomes is hoped to proceed without a chilling effect on venture capital or small businesses, even as leaders set frameworks for value-based decisions without directly making patient denial choices.