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

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

What to Cover?

Dollars per Life Year $600,000 Gained $500,000 $400,000 $300,000 $200,000 $100,000 $50,000 Years of Life Gained

Dollars per Life Year $600,000 Gained $500,000 $400,000 $300,000 $200,000 $100,000 $50,000 Years of Life Gained

Dollars per Life Year $600,000 Tarceva (Pancreatic cancer) Gained Who Decides? $500,000 Govt, Insurers, Doctors, Patients, Abraxane $400,000 or Voters? (NSCLC) $300,000 Is there one $200,000 answer for Abraxane everyone? Herceptin (metastatic breast cancer) $100,000 (metastatic breast cancer) Why not Herceptin prevent $50,000 (adjuvant therapy) cancer? Years of Life Gained

Whom to Cover versus What to Cover?

Whom to Cover 350 m 300 m 250 m 200 m 100 m 50 m What to Cover

Whom to Cover 350 m 300 m 250 m 200 m 100 m 50 m What to Cover Proton for Medicaid Prostate Cancer

Who Whom to Cover Decides? 350 m 300 m States, Feds, or Insurers? 250 m 200 m Is there one answer for everyone? 100 m 50 m What to Cover Proton for Medicaid Prostate Cancer

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

Whom to Cover 350 m 300 m 2010 250 m 2018 200 m 2025 100 m 50 m Proton for What to Cover Prostate Cancer

Proton Beam Accelerator Facilities Operating, Planned, or Under Construction 25 Proton Beam Accelerator Centers 20 15 10 5 0 1990 1995 2000 2005 2010 2015 2020

Proton Centers in Construction or Under Development 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

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