Improving Cancer Care in Medicare

May 5, 2009 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, Innovation, Politics, Quality of Care & Safety, Therapeutic Substitution & Interchange / 1 Comment

This week’s AMA News includes an article about how cancer care for Medicare beneficiaries has improved because of a provision in last year’s Medicare Improvements for Patients and Providers Act (MIPPA). The provision of interest clarified that Medicare Part D plans need to pay for off label uses of medicines to treat cancer when there is supportive evidence in the peer-review literature. This changes became effective January 1st, and for at least one patient, it has improved their care. (See the Medicare Rights Center’s press release about the coverage appeal they won for a client because of the new law.)

However, as I noted in an interview with the American Medical News ReachMD Radio-XM 160, (See MP3 audio file below), because the change only applies to cancer treatments, patients with other serious and life threatening illnesses may still find their treatment options limited. …

Business Perspectives on Comparative Effectiveness Research

May 2, 2009 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare / No Comments

Comparative effectiveness research continues to be a hot health policy issue for many companies and stakeholders, in part, because they’re concerned that CER information will be used to deny access to innovations because of cost.

I recently talked with Jeff Sandman, CEO of Hyde Park Communications, about how healthcare companies should productively approach CER issues, and how quickly CER would lead to dramatic changes in the healthcare system. (See part of our conversation below.)

There will certainly be more reports, seminars, meetings and Congressional hearings about CER as the $1.1 Billion in ARRA funding for CER is distributed, and the results of that research begins to roll in.…

Making Health Reform Work

May 1, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Miscellaneous / No Comments

With momentum for health reform continuing to build, events have overtaken the scope of the book I’ve been writing – which has had the working title “Fixing the US Healthcare System.” Therefore, I’m reconstituting the draft text and outline to increase the focus on how to effectively implement changes in the healthcare system – while still discussing the substance of reform. To highlight the need and importance of effective implementation, the new working title is “Making Health Reform Work.” (A one page summary of the book can be found here.)

“Making Health Reform Work” will be different from other health reform books by going beyond just describing the health system’s problems and recommending solutions, to also exploring processes for effectively implementing positive changes and reforms.…

Investment for Health Reform – Escaping the Valley of Death

April 30, 2009 / Michael D. Miller MD / Comparative Effectiveness, Health System Reform, Innovation, Quality of Care & Safety / 3 Comments

The debate about health reform has mostly focused on expanding insurance coverage and controlling costs. However, successfully improving the US healthcare system will require some long-term quality improving investments.

The stimulus bill (ARRA) included two such investments. The $1.1 Billion for Comparative Effectiveness Research has been widely discussed because it is important, and a very large percentage increase in the Federal Government’s spending in this area. But the ARRA bill also included $10 Billion to increase NIH’s funding.

The significance of the increased NIH funding is twofold: First, it will provide expansion of biomedical research related jobs. And second, it will help the NIH increase the work it does in translational research, which should help biomedical research build a better bridge over what the Parkinson’s Action Network and others have labelled the “Valley of Death.”…

30% Off Health Care

April 27, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Politics / 4 Comments

I get lots of emails. Some are interesting. Others are Spam – such as the one offering to double my gas mileage by showing me how to run my car on water. (Don’t they know that cars run on air not water!!!!!)

And last week I got one promising to cut health care expenses by 30%. Not just my health care expenses, but the entire countries spending on health care. (See their promotional coupon below.)

As you can see, this is really a call for people to support a public plan as part of health reform. This is a great message and marketing gimmick, but the problem is that nobody has agreed on the definition of a “public health insurance option.” …

Humana on Health Reform

April 19, 2009 / Michael D. Miller MD / Economics & Financing, Health System Reform, Miscellaneous / 3 Comments

Humana has added another “educational” to its YouTube series – this one is about “why do we need health reform.”

It’s a good question, and since I’ve been somewhat critical of other Human videos, I feel obligated to say that this one is OK – mostly because it doesn’t contain too much substance, i.e. it’s a mile wide and an inch deep. And I do want to give the writers credit because the video starts by answering the question about what is health reform and why do we need it by stating, “The simple answer is…. Well there is no simple answer.”…

Butterfly Effect in Health Reform

April 16, 2009 / Michael D. Miller MD / Health Policy and Communications Blog, Health System Reform, Politics / No Comments

A short piece about Tom Daschle in last week’s National Journal made me think about the importance of the presence, actions, and attitudes of individuals for the direction, success and failure of health reform initiatives. This is sort of like the “Butterfly Effect” of health policy. [Background: The “Butterfly Effect” is a thought experiment related to chaos theory, and is based upon the theoretical concept that how a butterfly flaps its wings can dramatically change the weather thousands of miles away.]

Senator Daschle was very qualified to lead the Administration’s efforts on health reform, but several factors led to his removing himself from consideration to be Secretary of HHS. …

Culture of Health Reform

April 13, 2009 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Federal Healthcare Reform, Politics, State-Level Healthcare Reform / 2 Comments

One of the challenges for health reform legislation is the culture of the policy and political community.

Massachusetts’ insurance and coverage initiatives have been cited as lessons for health reform at the Federal level and other states. However, while observing a meeting of the state’s Special Commission on the Health Care Payment System last Friday, I was struck by how the culture of this group was very different than what I have often seen in Federal processes or within other states.

The Commission had agreed at their previous meeting that global payments should replace fee-for-service as the main payment route for medical services and products. …

Health Reform With a Public Plan or Not?

April 9, 2009 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics / 5 Comments

National Journal’s cover story last week (“The Deal Busters“) was about the 4 issues that could kill health reform. And first on the list was creating a public health insurance plan option to compete with private insurers in the push for increasing coverage.

The National Journal does a great job of describing the stakeholder groups’ political pros and cons around a public plan, but it doesn’t delve too deeply into the policy implications of expanding health insurance coverage with or without a new public plan option. That issue was recently discussed in Charlie Baker’s blog – which included several key points about public versus private insurance plans:

Public plans often set the standard that private plans follow, and thus are not neutral actors in the market – Medicare is often ascribed such a market tilting role
Public and private plans face different financial pressures, i.e.

…

Comparative Effectiveness, Efficacy, Evidence Based Medicine, P4P, etc…

April 6, 2009 / Michael D. Miller MD / Comparative Effectiveness, Delivery of Healthcare, Economics & Financing, Health System Reform / 1 Comment

Comparative Effectiveness Research (CER) is being talked about more and more as a fulcrum for controlling healthcare costs. For example:

The Congressional Budget Office issued a report on CER in December 2007 and has highlighted it in more recent analyses and reports about health reform options
The ARRA legislation included $1.1 Billion for CER
ARRA included language for the IOM Committee on Comparative Effectiveness Research Priorities to provide a report by June 30, 2009 about how to spend the $400 million allocated to HHS for CER.

All this discussion has kept me thinking about how CER will be done, how the results from this research will actually be used to improve quality and reduce costs, and what are the scope of healthcare issues that CER is, will, or should be applied to help improving.…

Health Reform Dialogue – Does and Doesn’t Achieve…..

March 30, 2009 / Michael D. Miller MD / Health System Reform, Politics / 1 Comment

The self-named Health Reform Dialogue of executives from 18 leading health and business organizations met for 6 months and released its report on Friday. Consensus within this group is better than no consensus, but I’d hoped for a bit more substance in their report – which is what usually comes out of projects facilitated by the Keystone Center.

The group apparently did agree on an individual mandate to have insurance – but their inability to agree on a public plan option for all individuals reportedly led to 2 unions leaving the project before its completion. However, the report also includes some items that are so general they don’t pass the head scratching, “that’s so obvious but where are the specifics?”…

Precedents and Comparisons for Health Reform

March 23, 2009 / Michael D. Miller MD / Health System Reform, Medicare / No Comments

Discussion of health reform this year often touches upon how the process and substance are so different than what occurred in 1993-4, even though many of the people engaged in the current effort were also involved then too.

Historical events are clearly important for setting the political and policy environment for any legislation, and in healthcare there are very clear examples of stagger-stepping to success:

At the Federal level, health insurance/coverage laws and proposals date back to the 1930s:

National health insurance for the elderly was supposed to be the second part of a new social safety net – after the creation of Social Security
Medicare and Medicaid were created in 1965.

…

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