The Daily Rise: Friday, July 15

ICER Reconsiders Value Framework

Patients are speaking up. And ICER is listening.

The Institute for Clinical and Economic Review announced yesterday that it was soliciting nationwide input from all health care stakeholders on ways to improve its value assessment framework.

“We invite all interested parties to provide comments on the current ICER value framework, highlighting elements that are perceived to work well and others that should be re-examined,” the organization said in a press statement. “Where change is recommended, we are most hopeful of receiving specific proposals presenting alternative methods accompanied by arguments examining the potential advantages and disadvantages of multiple options.”

This is great news. It’s a sign that patients are having an impact on shaping the future of health care. ICER’s value framework is likely the foundation for payers to make decisions about what treatments will be available to patients. Consequently, it’s vital that patients be actively involved in any conversation or debate about frameworks that claim to define value.

Join us in making your voice heard by submitting comments to ICER. There is no page limit to the comments but here are ICER’s guidelines

  • Deadline: Comments must be submitted by Friday, September 12.
  • Times New Roman, 12-point font size
  • Word document (no PDFs)
  • Electronic copy only

Comments should be sent via email to publiccomment@icer-review.org

ICER for Medicare — Not So Fast

We’re concerned about ICER’s decisions because of the far-reaching implications. Not just for private health care, but also public care.

Donna Cryer, an IBD and liver transplant patient who also serves as President and CEO of the Global Liver Institute, cautions that ICER’s decisions could be used by Medicare to evaluate value and then restrict patients’ access to treatments.

“If Medicare Part B adopts ICER or any cost-based determination of value,” Cryer writes at Morning Consult, “it will be opening Pandora’s box to a dangerous world of rationing that has rightfully galvanized the patient community.”

Cryer makes a great point: value frameworks that limit access and force one-size, fits-all treatment run counter to precision medicine.

“Patients want access to the innovation brought forth by the President’s Precision Medicine Initiative so that health care is valuable to the patient, the ultimate payer,” Cryer says.

The Dangers of Clinical Pathways

Who gets to define value?

We’ve been asking that question for months, and we’re glad to see the Huffington Post join the chorus.

Writing at the Huffington Post, Kim Thiboldeaux, CEO of the Cancer Support Community, says that she’s “baffled” that so “many proposals and programs being discussed and even launched in the marketplace were developed with limited input from patients.” She identifies “clinical pathways” as the most troubling strategy for reducing costs.

What is a clinical pathway? According to the Children’s Hospital of Philadelphia, a clinical pathway is “a task-oriented care plan that details essential steps in the care of patients with a specific clinical problem and describes the patients expected clinical course. The goal of clinical pathways is to standardize care, improve outcomes and reduce cost.”

In other words, a clinical pathway is the opposite of getting the right patient the right treatment- right now.

“I am not opposed to reducing costs, but I am opposed to reducing care,” Thiboldeaux writes. “Furthermore, the pathways that I’ve seen are better described as drug pathways rather than true clinical pathways. Once again, the patient is viewed through the myopic lens of biology and not the wider lens of humanity. Doctors are being incentivized to keep patients on pathways to reduce costs but I believe that if you incentivized actions toward comprehensive care, the patient would have better outcomes and the system would save money.”

Video of the Week: #SagerStrong

This week, TNT reporter and Leukemia patient Craig Sager offered an emotional speech as he accepted the Jimmy V Award for Perseverance at the ESPYS. Sager has continued to work as a sideline reporter for NBA playoff games, while receiving chemotherapy treatments.

“I will never give up, and I will never give in. I will continue to keep fighting, sucking the barrel out of life, as life sucks the marrow out of me. I will live my life full of love and full of fun. It’s the only way I know how.”

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