Translating a Biologic Revolution into an Organizational Overhaul — Retsef Levi

Retsef Levi

MIT Sloan Prof. Retsef Levi

From NEJM Catalyst

Thanks to the revolution in biologic therapy, the annual number of intravenous infusions at the Massachusetts General Hospital (MGH) rheumatology clinic’s small (two-chair) infusion center increased from 1,247 to 1,856 between 2009 and 2014. Related billings skyrocketed from nearly $16 million to more than $40 million. To understand this major shift, one must pause briefly to appreciate the medical history that led to it and then to examine how MGH is redesigning its care processes to bring these novel therapies to patients. Central to the plan is a collaboration with academic partners at the MIT Sloan School of Management.

The Medical Backstory

In 1980, a rheumatoid arthritis (RA) patient at the MGH rheumatology clinic would have received a weekly in-clinic infusion of gold salts and, occasionally, undergone laboratory monitoring.

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A way forward toward affordable, quality healthcare — Joseph Doyle

MIT Sloan Assoc. Prof. Joseph Doyle

MIT Sloan Assoc. Prof. Joseph Doyle

From The Hill

Most discussions about the state of the U.S. healthcare system start with the problem of unsustainable cost growth. One reason costs have been rising is that we (as a society and as consumers) find enormous value in health improvements and are willing to pay for them. The real question is how to identify value vs. waste in healthcare so we can increase efficiency to bring costs down.

Over the years, we’ve seen many attempts to revamp the healthcare system, but they have been insufficient to be transformative. A good example is the HMO model in the 80s and 90s, which was notorious for restricting access to care. During the healthcare reform debate, voters balked at the U.S. government coming anywhere near restraining spending on healthcare. Read More »

Americans forced to work through their retirement are missing out on an “encore adulthood” — Lotte Bailyn

MIT Sloan Professor of Management, Emerita Lotte Bailyn

MIT Sloan Professor of Management, Emerita Lotte Bailyn

From Quartz

How do today’s Baby Boomers—many of whom are still healthy and active—view their retirement? The traditional image of these so-called Golden Years involves leisure and freedom: mornings on the golf course, afternoons puttering in the garden, perhaps with some globetrotting and grandchildren thrown in for good measure. (Of course this option is only open to those who through pension plans or savings have the means for it.

In recent years, a second image of retirement, known as “aging in work,” has emerged. This model, borne in response to the economic need to protect Social Security and retain experienced workers’ knowledge, keeps retirement-age employees working in part-time or contract positions. It’s sold as win-win: Companies and the country benefit financially, but employees benefit, too, because it keeps their brains active and their social networks strong. The assumption is that continuing to work, though under better, more flexible conditions, is what makes people happy. The mainstream media back the model. Why Working Longer Is Good For Your Health and Get back to work! Working past “retirement age” is beneficial are just a few recent headlines.

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How Obamacare inadvertently threatens the financial health of small businesses, and what states should do about it — Robert Pozen

MIT Sloan Senior Lecturer Robert Pozen

MIT Sloan Senior Lecturer Robert Pozen

From Forbes

Starting in 2016, push comes to shove for small businesses under the Affordable Care Act, better known as Obamacare. As of January 1, small businesses, broadly defined as firms with 50 to 100 full-time employees, must comply with the ACA’s employer mandate and provide qualified health insurance to their workers or face stiff penalties. But this requirement poses a big threat to the financial stability of small employers—and not for the reasons you might think.

Obamacare includes a myriad of regulatory incentives and exemptions that define the parameters of the employer mandate. However, these have inadvertent consequences. Most important, exemptions in the ACA encourage small firms to self-finance their health care plans—that is, pay their workers’ health care bills directly, rather than covering them through a traditional insurance policy. Most large companies in America (above 3,000 employees) engage in self-funding, but that is done now by only about 16% of small companies of between 50 and 100 employees. According to my research, that number is set to rise.

It’s understandable that small companies see self-funding as the superior option. By financing their own health care plans, they stay exempt from the community rating requirements that restrict how much insurers may vary premiums based on factors like age and smoking status; they also stay exempt from the federal and state taxes on most health care premiums that are paid to traditional insurers.

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‘Health care loans’ for Hep C cure — Andrew Lo and David Weinstock

MIT Sloan Professor Andrew Lo

MIT Sloan Professor Andrew Lo

From Boston Globe

A new class of medications was recently approved that cures more than 95 percent of people with Hepatitis C in only six weeks at a cost of about $84,000 per person, and new therapies with price tags that are likely to exceed $1 million per person are now available or coming soon. How can patients possibly afford them?

In an article published in the journal Science Translation Medicine, we outline a feasible market-based solution that could immediately expand access to transformative medications, including cures for Hepatitis C and cancer. The basic concept is to convert a large upfront medical expense into a series of more affordable payments, akin to getting a mortgage when buying a house. The challenge of curative medications that only require a short course of therapy is that the whole price is paid upfront — how many homeowners could buy their houses using only cash? Instead, most home buyers get a mortgage and make monthly payments for as long as they benefit from owning the house or until the full amount is paid. We propose the same solution to overcome the liquidity problem that prevents access to curative medications, which we call “health care loans,” or HCLs.

The second problem with upfront payment is the possibility of buying a “lemon.” Patients could unexpectedly relapse, die, or suffer a terrible side effect, in which case there’s no opportunity to recoup a portion of the upfront payment. Therefore, we propose that amortized payments stop if the benefit stops (i.e., if the “cure” doesn’t cure), thereby linking payment more closely to therapeutic value.

There are, of course, many complex ethical considerations and social ramifications related to the pricing of highly effective therapies above a threshold that permits universal access. Price gouging — like the recent 5,000 percent increase for a generic medication by Turing Pharmaceuticals — is a concern. To address this, some politicians and advocacy groups have proposed that prices be capped by legislation. Capping prices would stifle innovation and disincentivize drug development, the exact opposite of what we need.

Our HCL proposal has many advantages over price caps. It incentivizes (rather than disincentivizes) the development of highly effective therapies, because the greater the benefit, the greater the payment. And it can be implemented immediately. Our calculations indicate that bonds with competitive return characteristics could be raised to support HCLs across a range of financial scenarios. The creation of a large and liquid market for HCLs would give payers and lenders greater negotiating leverage with drug makers to get better pricing. Linking payment to value would establish a paradigm in which medications that offer very little benefit, like many of the recently approved cancer therapies, could not have exorbitant prices.

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