As the foundation of the healthcare policy landscape undergoes a tectonic shift that promises to reward “value” in care rather than “volume” of services, stakeholders of all types have cautiously applauded these changes as needed reforms. Yet, when patients see these principles applied – as is the case with a recent Medicare Part B Drug Payment Model – we can’t help but ask: “value to whom?”
Health insurers, public and private, should support the provision of care that taxpayers, employers – people – find valuable to optimizing health. However, all too often payer perspectives don’t align with those of patients, caregivers, and clinicians. The latest misalignment of payer and patient perspectives comes in the form of a Medicare proposal which would rely on cost-based recommendations from groups like the Institute for Clinical and Economic Review (ICER) to determine the “value” of care for patients. While ICER purports to be an independent, unbiased arbiter of value assessment, their analyses are intended for use by payers – often at the expense of patient access to life-saving medications.
On the other hand, the President’s recently reiterated his promise for personalized medicine in a Boston Globe editorial, stating, “Instead of trying a one-size-fits-all treatment, what if medical experts could tailor one specifically for everyone’s body?” Exactly what patients have been saying.
About the Author
Donna Cryer, an IBD and liver transplant patient, is President and CEO of the Global Liver Institute.