Many of us who have been in the healthcare arena for a period of time can reflect back over the past 20 years where predictions of technology overwhelming our ability to pay has been continuously predicted. When Part D became a reality of government coverage we all got a societal perspective on what we would face regarding prescription benefit coverage. Over the past few years we have continued to evolve in terms of data driven decision making and in some cases this has lead to the ability of payer organizations to contract with suppliers with “Value Based” parameters.
In many cases the value based orientation is based on agreeable and measurable outcomes for all parties. This agreement orientation is based on clinical outcomes data from scientific literature and suppliers, matched to adherence criteria and a data competent care delivery organization who can collect information required to allow for a fair adjudication of what value the outcome produced. We know that while this sounds simple the devil is in the details.
But what are the next challenges? How about Rare Diseases, Genetic Based Oncology treatments, and Curative Therapies – these issues are all playing out before our eyes and will continue to challenge our health policies going forward. These are the expansive technologies on a private and public payer basis we are facing today. I believe, as I am sure all of our TPG-NPRT participants do, that we will find a way forward to answer these perplexing questions and offer these technologies to our patients. I hope that this debate continues to take place at our TPG-NPRT meetings, as I know that only the interface and discussion venue we provide will help us develop orientations that allow technology to reach its intended targets – OUR PATIENTS.