Advancing Solutions for Rising Health Care Costs: Innovation, Policy, and Practice
Health care cost trends overall are increasing at an unsustainable rate, with PricewaterhouseCoopers, LLP, projecting an 8% year-on-year medical cost trend in 2025 for the group market and 7.5% for the individual market. Today’s medical cost trend is an urgent call to action for stakeholders to rethink how they can better manage the total cost of care. One strategy is to reengineer financial, workforce, and business models. Stakeholders should capitalize on each transformational opportunity—from investments in innovation and technology to strategic partnerships—to overcome the inflationary chokehold and move toward a different cost and business model. Finding innovative and effective ways to control cost is the common theme of this issue.
We start with a look at the current activity at the federal level. In his COA Viewpoint column (page 28), Ferreyos states that although there have been unprecedented medical advancements, barriers such as rising costs, hospital consolidation, and bureaucratic red tape prevent access to affordable, high-quality care. Ferreyos highlights COA’s Prescription for Health Care Reform—a comprehensive, five-part plan outlining specific, achievable solutions for policymakers to fix what is broken and ensure every patient can access the care they deserve. The report cites a wide range of activities, including the 340B Drug Pricing Program, pharmacy benefit managers, and reimbursement reform. COA also calls for reevaluation of certain aspects of the Inflation Reduction Act (IRA), which has the potential to adversely impact independent oncology practices.
As noted in our Transformative Business Trends column (page 31), Vogenberg addresses how large employers are entering a new era in their benefit offerings, driven by legal and financial concerns. Employers are leveraging data-driven decision-making, engaging in direct-with-manufacturer collaborations, and pursuing predictive benefit modeling to create sustainable, employee-centric plans. While trying to meet employees’ coverage expectations, employers must consider the total cost of care, premiums, and out-of-pocket costs by employers and their plan members. Vogenberg suggests that there needs to be a shift in how health care benefits are structured and delivered. Pathways should be used throughout the full patient journey to enhance clinical effectiveness and help provide a balance of clinical access and financial cost to deliver optimal outcomes.
Not to be left behind, providers are now suggesting more cost-efficient ways to reimburse for treatments. In our Original Research article (page 12), Geisler et al discuss the potential impact of indication-specific pricing for the targeted therapy bevacizumab based upon a willingness-to-pay threshold of $100 000 per quality-adjusted life-year. In our Review article (page 19), Ascha et al examine the use of bispecific antibodies, barriers to their adoption in community clinics, and how remote therapeutic monitoring can streamline and support toxicity management for patients undergoing this treatment, improving patient outcomes and reducing the cost of adopting this novel therapy.
We hope you find the articles in this issue informative, as they offer solutions for better managing the total cost of care in an unstable market. The Journal of Clinical Pathways is always open to receiving your submissions highlighting your work and research in the space throughout the year. Submissions can be submitted at JCPonline.com.
