Engage minoritized patients to address medical mistrust | Experts discuss evolution of alternative payment models | Report: 25 drugs cost Medicare $50B in 2022
Dr. Brita Roy of the NYU Grossman School of Medicine highlights the importance of engaging minoritized populations to address medical mistrust, emphasizing hiring community members as clinical trial coordinators. Roy also discusses a need for the incoming presidential administration to prioritize health care equity by ensuring access to basic needs, education and health care.
Alternative payment models in health care, such as accountable care organizations and the Oncology Care Model, have been explored as ways to improve costs, efficiency and care quality, but these models face challenges such as patient engagement and financial risk. The Enhancing Oncology Model attempts to address these issues by focusing on specific cancers and introducing mandatory downside risk, but uptake has been limited due to concerns over reduced management fees and financial risks, experts note in a discussion.
An AARP report highlights the 25 drugs on which Medicare has spent the most, costing the program $50 billion in 2022 as average list prices have nearly doubled since market entry. The medications, which include Ozempic and Trulicity, have not been selected for price negotiations under the Inflation Reduction Act despite their high costs, although Leigh Purvis, prescription drug policy principal at AARP's public policy institute, notes that some will likely be part of the next round of negotiations.
The CMS has proposed a 2.23% increase in Medicare Advantage benchmark payments for 2026, translating to a $21 billion rise in payments to MA plans. This proposal contrasts with a 0.16% decrease last year and continues the implementation of the MA risk adjustment model.
Health care in 2025 will see significant challenges and advancements, according to internist Dr. Toni Brayer. Access to primary care will remain difficult, with telehealth and nurse practitioners filling some gaps. The FDA will be split into separate food and drug entities, potentially reducing regulations for medical devices and tests. Artificial intelligence will enhance personalized medicine and radiology, and home health care will become more essential as baby boomers age, Brayer notes.
Phoenix Children's has implemented a comprehensive program to address social determinants of health, using proprietary technology to screen patients and connect them with resources. The initiative, led by chief medical information officer Dr. Vinay Vaidya, has identified issues such as food insecurity and mental health needs among nearly 20% of families. The hospital has partnered with community organizations and the state to manage these needs, demonstrating the importance of data analytics in improving patient outcomes.
A Milliman report found that Together Senior Health's RADAR algorithm, which identifies cognitive impairment, shows significant predictive value when using claims data. The algorithm may enhance value-based care by identifying patients at risk for undiagnosed dementia without requiring patient involvement.
The FDA has mandated that RSV vaccines from GSK and Pfizer include a warning about Guillain-Barre syndrome after data indicated a potential link. The FDA emphasized that the benefits of the vaccines still outweigh the risks, noting that the vaccines are a major tool against RSV, especially for adults older than 75.
A study in JAMA Network Open finds that a high burden of infections in early life is linked to an increased risk of moderate to severe infections and systemic antibiotic use up to age 13. Researchers analyzed data from the Copenhagen Prospective Studies on Asthma in Childhood, involving 614 children.
Health care workers in Los Angeles are facing significant challenges due to wildfires, with many losing homes or being evacuated. Despite personal losses, staff at hospitals like Providence St. John's and City of Hope remain dedicated to patient care. Staffing shortages arise as workers are unable to reach facilities, and some hospitals are operating with limited resources, relying on backup power and canceling elective surgeries.
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