Episode 111: Costly Breakthroughs in Oncology and How Payers Will Adapt with David Guy from Aventria Health Group

Published: Oct. 20, 2016, 11:30 a.m.

Currently SVP of Oncology and Specialty Market Programs at Aventria Health Group.\xa0 Formerly was \xa0CCO at Favrille, VP Strategic Marketing at Schering AG and Head of Oncology Marketing at Genentech; was instrumental in the commercialization of Taxotere, Fludara, Herceptin, and Rituxan


00:00 New Oncology Breakthroughs.
02:35 Extending survival time to stabilizing curves that could extend to future cures.
03:50 The average cost of a new Oncology product is more than $100,000 for annual cost of treatment.
04:15 \u201cThe question is how, as a Health System, we\u2019re going to be able to manage that.\u201d
04:30 What Payers are doing to afford these new Oncology Breakthroughs.
04:50 Creating Pathways and Incentivizing Providers to use these Pathways.
05:20 The difference between a Pharmacy Benefit and a Medical Benefit.
05:50 \u201cBuy and Bill.\u201d
06:30 The potential for Providers to make a significant portion of their income from purchasing more expensive products.
07:00 Medicare\u2019s adopted average selling price & demonstration project for Buy and Bill.
07:50 How Bundled Payments is affecting the cost of Oncology.
09:00 The Oncology Care Model and shifting to an Episodic Care Model.
09:50 The Evidence-Based approach to treating patients.
10:15 NCCN Guidelines.
11:00 \u201cAs long as the Pathways reflect the Gold Standard.\u201d
11:50 Payers are trying to get more consistent care, rather than trying to limit the cost of care.
12:15 Laws requiring Payers to cover Oncology treatment.
14:00 The importance for Manufacturers to communicate and demonstrate the value of their medication.
15:00 Creating a Step Approach.
16:20 Change in the future allowing Medicare negotiate prices with manufacturers.
17:50 David\u2019s advice for Pharmaceutical manufacturers.
18:15 Value-Based Contracting.
18:40 Risk-Sharing Program.
19:20 Paying by the Pill vs. Paying by the Value Medication Delivers.
19:40 A more Value-Based Reimbursement system.
20:00 You can find out more at AventriaHealth.com.