Notes from the recent panel discussion The Future of NY Healthcare. All about Oscar, TrumpCare, Value-based care, Drug prices, Single-payer, and more!
The future sure ain’t what it used to be! When I was younger, I thought by 2017 we’d all be tooling around in personal hovercraft, gliding a few feet off the ground.
Instead I find myself going to panel discussions about value-based payments! It’s interesting, although not as fun as driving a hovercraft…
Here are some ideas that stood out during the recent NYC Health Business Leaders panel discussion. Please note this is my completely unofficial point of view, and may not reflect what the panelists intended.
Oscar web demo
As a marketer, I was impressed by the Oscar demo. The Oscar website and app seem to be very effective at influencing user behavior to meet business goals.
For example, the website promotes providers who choose to be fully integrated with the Oscar app. Oscar also drives traffic to a “concierge team”, consisting of 3 non-clinical staff members and one nurse. But it’s an open question whether the user behavior that Oscar encourages for a better bottom line completely aligns with the patient’s best interest.
Recently, Oscar cut the number of in-network providers in half, and retained 65% of their members. They feel that’s a win.
Big pharma and accountability
Pockets of untethered costs are embedded in the current value-based system with no accountability to community health.
The prime example is big pharma, where some drug costs are set according to what the market will bear, without reference to the healthcare needs of the community. For example, payers are concerned about a sickle cell anemia drug with a projected cost of $1 million per shot. Panelist HealthFirst has 2,500 sickle cell anemia patients, many on Medicaid.
Furthermore, big pharma can act as if they have no accountability after a product is dispensed. But for pharma to fully participate in a value-based system (and justify their prices), they need to be accountable for adherence — and abuse (see opiates).
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Primary care – oversold?
Perhaps this does not apply to Medicaid primary care providers – but audience members were skeptical that primary care providers are able to engage patients in social determinants of health in a 15 minute patient encounter. Plus – private pay primaries tend to act as gatekeepers and technicians, not problem-solvers.
Will be a disaster for NYS organizations that depend on Medicaid funding. “We’ll be out of business”. TrumpCare will be an equal-opportunity disruptor – all provider sectors will be affected.
Just like prison closings, hospital closings or reductions in capacity are difficult to do because they are spun as job-killing changes.
Future of NY Healthcare panelists hate single payer!
They claim it will suppress market-driven innovation and quality, and drive up costs. This is puzzling!
Previously, panelists had complained at length about big pharma’s lack of accountability. Yet a robust single-payer system has been shown to be an effective counter-weight to big pharma.
Panelists also praised the performance of Kaiser Permanente, which, after all, is a single payer system.