On this episode of the podcast, Terry and Bob discuss how the Covid-19 pandemic can accelerate the movement toward value-based medical care and digital medical technologies. Bob speaks with Dr. Mark McClellan, former FDA and CMS chief and current director of the Duke-Margolis Center for Health Policy at Duke University, about the shift from fee-for-service to a model that values outcomes.
Dr. McClellan explains how Medicare Advantage is a partial value-based model. He argues that changing the healthcare system to focus on prevention, wellness, and identifying conditions can reduce costs and improve health outcomes. Hospitals amount for most healthcare spending, so to the extent that early intervention can keep patients out of the hospital, the more healthcare consumers can save on costs.
Another good example of value-based medicine is telehealth, whose use has been accelerated due to the pandemic. Most patients support telehealth, reporting positive experiences. It offers a convenient and safe way to get care. Reimbursement for telehealth is a good short-term solution, but Congress must explore ways to make it – and other value-based, 21st century solutions – permanent. Due to the pandemic-induced economic recession, patients will struggle even more to pay for their care, says Dr. McClellan. Policymakers must reflect this new economic reality in their forthcoming health policy decisions.
The healthcare news segment of the podcast discusses how hospitals have started a PR campaign in hopes of getting more government aid. What hospitals don’t mention is that they have already received more than $200 billion from taxpayers in previous taxpayer relief packages. With the help of this vast government aid, hospitals made $1 billion in profits in the most recent quarter. It’s difficult to feel sorry for hospitals with these financials, especially when they continue to charge inflated five-figure prices for routine procedures.
Terry and Bob also provide context to the severity of the Covid-19 pandemic – a perspective that is much-needed given the countless alarmist headlines. They explain that while cases have increased, the death rate has gone down. The Centers for Disease Control recently revised its death rate estimate to just 0.4 percent. When accounting for asymptomatic cases – the so-called infection fatality rate – this number falls to around 0.3 percent. Oxford’s Center for Evidence-Based Medicine has predicted an IFR for Covid-19 between 0.1 and 0.41 percent.
These figures should be included in media reports to offer balance to reporting on growing case counts.
Terry also highlights the new CMS rule that accelerates the use of co-pay accumulators, which insurers use to prevent copay assistance from counting toward annual deductibles or out of pocket maximums. As a result, patients are hit with massive costs mid-year when their co-pay assistance runs out but none of it has counted toward their deductibles. Terry and Stacey Worthy, counsel to Aimed Alliance and partner at DCBA Law & Policy, have a recent op-ed in Fortune that explains the threat of these co-pay accumulators to patients, especially those with chronic diseases.
Patient correspondent Kate Pecora talks to Danielle, who is immunocompromised and fears returning to work in New York City as the pandemic rages. Her employer has pressured her to return, but she has so far been able to work from home thanks to repeated doctor notes. Her plight is similar to what’s facing countless workers with chronic diseases across the country right now.
