When Are We Going to Get Serious About Health Care Spending in the - - PowerPoint PPT Presentation

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Oct 05, 2022 103 likes •264 views

When Are We Going to Get Serious About Health Care Spending in the US? Amitabh Chandra HARVARD BUSINESS SCHOOL HARVARD KENNEDY SCHOOL Uninsurance Care- Consolidation coordination 18% of GDP 25% of GDP Hospitals Prevention PBMs Pharma

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When Are We Going to Get Serious About Health Care Spending in the US?

Amitabh Chandra HARVARD BUSINESS SCHOOL HARVARD KENNEDY SCHOOL

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Uninsurance Care- coordination Prevention Pharma PBMs Hospitals Consolidation 18% of GDP 25% of GDP

SLIDE 3

What to Cover?

SLIDE 4

Years of Life Gained

$50,000 $100,000 $200,000 $300,000 $600,000 $500,000 $400,000

Dollars per Life Year Gained

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Years of Life Gained

$50,000 $100,000 $200,000 $300,000 $600,000 $500,000 $400,000

Dollars per Life Year Gained

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Years of Life Gained

$50,000 $100,000 $200,000 $300,000 $600,000 $500,000 $400,000

Dollars per Life Year Gained

Tarceva (Pancreatic cancer) Abraxane (NSCLC) Abraxane (metastatic breast cancer) Herceptin (metastatic breast cancer) Herceptin (adjuvant therapy) Who Decides? Govt, Insurers, Doctors, Patients,

r Voters?

Is there one answer for everyone? Why not prevent cancer?

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Whom to Cover versus What to Cover?

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Whom to Cover What to Cover

350 m 300 m 250 m 200 m 100 m 50 m

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Whom to Cover What to Cover

350 m 300 m 250 m 200 m 100 m 50 m

Proton for Prostate Cancer Medicaid

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Whom to Cover What to Cover

350 m 300 m 250 m 200 m 100 m 50 m

Proton for Prostate Cancer Medicaid Who Decides? States, Feds, or Insurers? Is there one answer for everyone?

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Unable to say no to low-value care, we create powerful incentives to produce even more low- value care…

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Whom to Cover What to Cover

350 m 300 m 250 m 200 m 100 m 50 m

Proton for Prostate Cancer 2010 2018 2025

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Proton Beam Accelerator Facilities Operating, Planned, or Under Construction

5 10 15 20 25 1990 1995 2000 2005 2010 2015 2020 Proton Beam Accelerator Centers

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1. Dallas Proton Treatment Center, Dallas, TX 2. Emory Proton Therapy Center, Atlanta, GA 3. The McLaren Proton Therapy Center, Flint, MI 4. Miami Cancer Institute at Baptist Health South Florida, Miami, FL 5. New York Proton Center, New York, NY 6. Georgetown Lombardi Comprehensive Cancer Center, Washington D.C. 20057 7. Johns Hopkins Sibley Hospital Proton Therapy Center, Washington, DC 20016 8. Los Angeles Proton Therapy Center, Montebello, CA 9. Scott Hamilton Proton Therapy Center, Franklin, TN 10. Stephenson Cancer Center Proton Center at University of Oklahoma, Oklahoma City, OK 11. University of Alabama, Birmingham. No info on timing. 12. Provision New Orleans, LA, groundbreaking before end of 2017 13. Provident ProtonCare, $85 M facility at the Baton Rouge Health District, LA, open end of 2019

As of 2018, there are 26 operational proton centers

Proton Centers in Construction or Under Development

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Debates on US Health care spending are characterized by:

Asking the wrong question: right question is to

question the value of spending

Difficulty in saying no to low-value care.
Unwillingness to acknowledge how low-value

care decreases ability to deliver other priorities

Struggle with being able to afford high-value

interventions

Attraction to something-for-nothing policies to

justify coverage for high-value care: prevention, population-health, consolidation=integration, March-in rights.

Ignoring incentives as a core principle for

increasing efficiency