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  #221  
Old 01-03-2018, 05:36 PM
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Originally Posted by George Frankly View Post
Inpatient events (lots of surgery, and quite a bit of acute care), radiation therapy, and imaging rack up a lot of cost, so drugs are 'only' about half.

We have some proprietary stuff, sure. We're also heavily invested in the CMMI Oncology Care Model, which you can google. It features both cost and quality components. The basic framework is that they measure savings (which is complicated enough). If you generate savings under their rules (big if!), then how well you do on about a dozen quality metrics determines how much of the savings gets paid to you. So, to succeed, you have to both reduce cost and take good care of your patients.

We have done capitated deals, but we cannot cap drugs, because there is too much risk. We've done some deals based solely on quality metrics. We did... I think 2-3 deals that are solely total cost deals. Most of what we've done, and what we're negotiating now, have both components.
That's really interesting, I've worked on the carrier side of these arrangements but mostly with primary care situations. I don't work in Health anymore but that was a lot of fun doing the calculations for new rates & risk sharing agreements.

Thanks for the CMMI reference, I'll try to read it on the bus tomorrow!
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Old Today, 11:53 AM
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Drug to treat chronic leukemia triples in price, after research indicates it can be used at lower doses. So patients may now take less of the drug, but it'll cost the same as before.

CMS spent $978M on Imbruvica in 2016 (most recent data I have), just to level set.

Last edited by George Frankly; Today at 12:05 PM.. Reason: Read some things wrong, sorry!
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