Value frameworks will decrease the quality of care provided to patients — Daily Rise: Friday, August 5

Are You Just a Number?

Are health care providers taking tips from the DMV?

Forbes contributor and University of Chicago economist Tomas Philipson warns that value frameworks will decrease the quality of care provided to patients.

“Given the widespread public concern about rising healthcare costs, there is a real risk that value frameworks will be used to justify access restrictions or price controls,” Philipson says. “New value frameworks in health care have emerged due to increasing cost pressures. Although value frameworks can be useful tools, they should be used to complement the patient-physician treatment decision-making process, rather than substitute for it.”

Some of the most promising medical advances are linked to personalized care — using technology to identify treatments that are tailored to the needs of each and every patient. Yet, when it comes to coverage, we’re moving in the opposite direction — with a perspective that emphasizes standardization and one-size-fits-all. Philipson says our best hope will be to keep the focus on getting the right treatment to the right patient.

“Future approaches for measuring treatment value should avoid one-size-fits-all approaches that do not capture factors that patients care about, while at the same time maintaining the primacy of the patients and physicians decision-making process,” he writes. “This entails getting away from “one size fits all” rules as well as including all treatment aspects that matter to patients. This will resolve the stark difference between many valuation frameworks that deem treatments to be low value and patients who are willing to go bankrupt to access them.”

Improving Our Health Care System

With daily news of more rate hikes and insurance companies dropping coverage, many are wondering if we should embrace a major change in our health care system.

Sally J. Pipes, the president, CEO and Thomas W. Smith fellow in health care policy at the Pacific Research Institute, writes that expanding the Affordable Care Act with a public option won’t make things better. She offers a hypothetical scenario of a Brooklyn couple earning $63,000 per year.

“Under Obamacare, they get no help paying for a mid-level Silver plan that costs almost $9,000 a year in premiums,” she explains. “That’s nearly 14 percent of their income. And that’s before paying rent, student loans or other monthly expenses.”

That’s IF they can get health coverage from the exchange. With so many insurers dropping coverage, it can be a challenge to get and keep coverage.

Pipes’ expresses optimism that House Speaker Paul Ryan’s health care plan will address these problems. Although Speaker Ryan has yet to offer the specifics, he has presented major themes.

“The Ryan plan hasn’t yet floated the proposed amounts of its age-based credits. But under one proposal advanced by House Budget Committee Chairman Tom Price, R-Ga., a physician, that same young Brooklyn couple could get $2,400 in tax credits to help cover the cost of a health plan.”

CVS Health is Rationing Health Care

Earlier this week, we told you about CVS Health’s outrageous – and unconscionable — actions that block patients’ access to more than 131 treatments — all as a strategy for maintaining their multi-billion dollar profits.

CVS Health spokeswoman Carolyn Castel admitted that “it’s the first time that brand-name cancer drugs have been taken off CVS’s standard formulary.” CVS Health will no longer cover treatments for leukemia and prostate cancer in 2017 — part of a 36 percent increase in the number of life-saving treatments not-covered by the company. In 2017, CVS Health will ban three-dozen more treatments, bringing the total number of excluded drugs to 131.

It’s bad for patients. But, CVS Health rationing of care is only just beginning. In its note to investors, CVS Health says it will drop more treatments in the near future — including treatments with no alternative.

“On a quarterly basis, products … may be evaluated and potentially removed from the formulary,” CVS Health promises investors. “We are also taking steps to address “limited source generics” which are products with limited generic manufacturers… These products will be evaluated and if appropriate, be excluded during the year.”

Are you affected by CVS Health’s decision to block life-saving treatments? Check out the list.

Americans Want Action on Zika

Americans want action on Zika virus.

According to a new Morning Consult survey, 61 percent of Americans want immediate action from Congress to address the public health crisis. A whopping 77 percent of respondents say that they are well informed about the virus.

For months, Congress has been in a stalemate over how much money to allocate to funding research into a vaccine for Zika virus. While Congress has been busy fighting over funding, many private companies have stepped up their investment in finding a treatment and vaccine. The American public is noticing.

Just 32 percent of Americans believe that the federal government is best equipped to handle Zika-related health issues.

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