Navigating healthcare affordability in the modern world

Navigating healthcare affordability in the modern world

2023-04-04T16:17:35-04:00April 4th, 2023|Economy, Face Off, Healthcare, Pittsburgh|

Writer: Eleana Teran

2 min read April 2023 – Dr. Stanley Marks, chairman of UPMC Hillman Cancer Center, and Dr. Bruce Meyer, executive vice president and Western PA market president at Highmark Health & Allegheny Health Network, shared their thoughts with Invest: about their approaches to tackling healthcare affordability. Both doctors discussed the need for more consumer-based access, remote care and phone access were topics of discussion between the two parties as well as the changing demand for healthcare services.

What strategies are you implementing to address affordability? 

Dr. Stanley Marks, Chairman, UPMC Hillman Cancer Center

A key issue we face is the high cost of immunotherapy drugs, especially the most common ones called checkpoint inhibitors or PD-1 inhibitors. Many of these drugs were developed in clinical trials conducted here at Hillman and cost about $200,000 a year per patient. The pharmaceutical companies that have developed and promoted them suggest that if it is working, the patient should stay on them for as long as possible, or until the cancer progresses or the patient becomes intolerant. However, we have initiated a clinical trial in our network that has a very innovative approach. We enroll patients in the trial and after they’ve been on this therapy for a year, we stop administering the drug and observe their progress. The trial has randomized the patients where some remain on the drug, while others do not. Although it is still early, we have had over 100 patients in this trial, and the results show no difference in patient outcomes with those who discontinued therapy compared to those who continue to take the drug. . The savings from stopping after a year are significant, especially for a drug that costs $200,000 a year. 

Dr. Bruce Meyer, Executive Vice President and Western PA Market President, Highmark Health & Allegheny Health Network

Healthcare is incredibly expensive in this country, and there are many things that we are working on to address this issue. One key aspect is improving health literacy, not just in terms of staying healthy and managing illnesses but also financial health literacy. It’s crucial that patients understand their copays, deductibles, and payment options, so they don’t have to choose between basic necessities like heating their homes and filling a prescription. We’re committed to working with patients to make healthcare more accessible and affordable. 

We are moving care out of the hospital setting and into outpatient facilities. For example, we recently started doing hip replacement surgeries in one of our standalone outpatient surgical centers with  a 25-30% lower cost generally for whoever is paying the bill. Finally, one of the main drivers of rising healthcare costs is the cost of drugs. Highmark and AHN are working together on strategies to mitigate those costs. For example, both organizations have invested in a nonprofit collaborative, CivicaRx, that manufactures its own generic medications, giving its member organizations price and supply stability. Highmark also recently partnered with a Pittsburgh startup, Free Market Health, that allows specialty pharmacies to bid on patients, getting the best prices for these incredibly expensive specialty drugs. While specialty drugs are used by just a fraction of our members and patients, they account for nearly half of the $5 billion that Highmark spends annually on prescription drugs.

How has demand for your services shifted and what does this say about the current market?

Dr. Marks:  I am primarily focused on overseeing the clinical services at Hillman, including medical oncology, radiation therapy and surgery. We’ve also established a network of cancer care delivery centers, which today is one of the largest cancer networks in the country. Our vision was to put cancer care in the community, so patients could receive high-quality care close to home and without having to travel to a city where most cancer centers are located. We’ve expanded the network to over 70 centers in Pennsylvania, Ohio, New York and Western Maryland, as well as in Italy and Ireland. Our model is based on recruiting top-notch physicians who are willing to become part of the fabric of the community and get involved with the hospital and medical staff leadership in those communities. We’ve been successful in integrating academic and clinical practices, so our academic physicians serve as experts and consultants to the clinical physicians. About 90% of cancer care can be delivered in a familiar setting for our patients, and our vision is to keep those patients close to home for chemotherapy or radiation treatment. If they need tertiary or quaternary care, they can come to the city, and then we’ll make sure they get back to the community after receiving treatment.

Dr.  Meyer: There are four areas to talk about. Firstly, the pandemic accelerated the move of many services that used to be taken care of on the inpatient side into the outpatient arena, creating a bigger demand for outpatient services. Secondly, there is a much larger demand for consumer-based access, such as virtual care and phone access. Lastly, people who postponed a lot of care during the pandemic are now coming back sicker. Our case mix index, which is the way we look at the severity of illness, has continued to climb. This is because they have delayed care for various reasons during the pandemic. The pandemic has affected everyone in this country, not just in healthcare, but also across all spectrums of business and life.

A fourth area that we are seeing in a more prominent way is the need for behavioral health. The pandemic was incredibly isolating for folks, and even coming out of the pandemic, we’re not done caring for COVID patients. We are still learning to live with it and manage our lives. This has had profound effects on people, and behavioral health has become a much greater issue for folks and has received much greater attention. We are still under-resourced, and we are still learning the best ways to provide behavioral health. One of the big shifts is that the bulk of our behavioral health services are now provided in virtual environments rather than in physical environments. This was not the case in 2019.

What is your outlook for your organization and Greater Pittsburgh’s healthcare industry over the next few years?

Dr. Marks: On the clinical side, we are continuing to expand and grow. We are currently operating in multiple markets, including regional, national, and international locations. Our footprint is expanding, and we are increasing our presence. In fact, we just opened a UPMC Hillman Cancer Center in Harrisburg. From a growth perspective, we are seeing increasing volumes of admissions and referrals, which is excellent news. On the academic side, we have several efforts underway, including increasing the number of thought leaders on the medical oncology side. In the past year and a half, we have recruited eight additional academic physicians, and we will continue to recruit experts in different disease sites, such as blood cancer, melanoma, breast and lung cancers. This is what sets UPMC Hillman Cancer Center apart from other centers and why we are an NCI-designated center. On the basic research side, we just opened a new research building called the Assembly, which is adjacent to the Hillman Cancer Center. It is a beautiful facility that provides a great collaborative environment for our cancer researchers. We expect to recruit additional basic science researchers in the next two or three years, in addition to the great team that we already have.

Dr.  Meyer: I’m incredibly excited about Highmark and what we’re doing in the community. One of the big reasons I came here is because of the Living Health vision and model that David Holmberg and Karen Hanlon have established. The model emphasizes the need for a seamless partnership between healthcare providers and healthcare payers, so that we can work together to take care of people in the best way possible. This involves combining resources, using data to make informed decisions and stewarding healthcare dollars more effectively.

We have an unsustainable trajectory in terms of the cost of healthcare in this country, and it’s incumbent upon payers and providers to work together to solve this problem. Our organization’s vision for the Living Health model inspires me, and I’m bullish about the future with Highmark Health. Our priority over the next few years is to create a blended, frictionless payer and provider model, not just between Allegheny Health Network with Highmark, but also between Highmark and the other providers that we collaborate and partner with within Western Pennsylvania, across the state, and in parts of New York, Delaware and West Virginia. Our goal is to set the standard and be a national pacesetter for integrating care and coverage in a manner that truly transforms health care.

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