Transcript Spatz Presentation - Alliance for Health Reform

manatt
A U.S. Perspective
Commonwealth Fund
Alliance for Health Reform
November 7, 2011
Ian D. Spatz
Points to make
The U.S. is Different
Search for Value Already Underway in U.S.
Success Depends on Investment in
Generating Data, Not Just Analyzing Data
Points to make
The U.S. is Different
Search for Value Already Underway in U.S.
Success Depends on Investment in
Generating Data, Not Just Analyzing Data
Wine Consumption
Source: 2009 Wine Institute
45.23
liters
45.23 Liters
24.44 Liters
20.72 Liters
8.96 Liters
Beer Consumption
Source: FAOstat (UN)
27.36 liters
102.24
102.24 liters
Liters
99.83 liters
86.08 liters
Obesity
Source: OECD Health Data 2005
Percentage of population with BMI>30
9.4%
12.9%
23%
30.6%
CT Scan Abdomen
Source: International Federation
of Health Plans, 2010 (U.S. avg.)
$179
$374
$187
$536
Bypass Surgery
Source: International Federation
of Health Plans, 2010 (U.S. avg.)
$16,325
$27,327
$13.998
$59,770
Cost Effectiveness
Cost Effectiveness
Comparative Effectiveness
Cost Effectiveness
Comparative Effectiveness
Patient-Centered Outcome Research
Points to make
The U.S. is Different
Search for Value Already Underway in U.S.
Success Depends on Investment in
Generating Data, Not Just Analyzing Data
Large, Empowered Payers
Express Scripts
CVS/Caremark
Germany
France
Medco
UK
MedImpact
90 million
85.1 million
81.5 million
65 million
65 million
63 million
32 million
Atlantic Information Services,
2010
Multi-tier formularies
Generic substitution
Prior authorization
Generics first
Drug utilization review
Risk sharing
Points to make
The U.S. is Different
Search for Value Already Underway in U.S.
Success Depends on Investment in
Generating Data, Not Just Analyzing Data
“Whether the addition of [product] to
chemotherapy regimens for [type of cancer]
improves health outcomes has not been
established.”
“It was not certain whether [product]
provides enough benefit to patients to justify
its high cost …, so NICE did not recommend
it.”
“We don’t know”
“We know it doesn’t help”
Starting in 2013, Medicare and all private
health insurance companies will pay a tax into
a trust fund that will support the activities of
the Patient-Centered Outcomes Research
Institute
Funding is estimated to reach $500 million
annually by 2015
Points to make
The U.S. is Different
Search for Value Already Underway in U.S.
Success Depends on Investment in
Generating Data, Not Just Analyzing Data