CER Daily Newsfeed

Using RWD, SDoH and Patient Mapping to Eliminate Blind Spots from the Patient Journey

(8/13, Stephanie Baum, MedCity News) comments “...Leveraging the immense, diverse forms of RWD, facilitated by the digitization of patient data, is revolutionizing drug development. It is advancing a more personalized approach to healthcare and helping clinicians to meet patients where they are. It is the only way forward to improve clinical study recruitment and participation and will help us develop more effective drugs that not only improve patient health for diverse patient populations, but also their quality of life. Reducing treatment side effects will also improve medication adherence and lead to a healthier, more robust healthcare industry.” Full

A Private Sector Approach To Cell And Gene Therapy In The US

(8/13, William H. Shrank, Steven D. Pearson, Mark B. McClellan, Health Affairs Forefront) comments “...Moving to a default of coverage with outcomes-based incentives would improve payer confidence, generate actionable real-world evidence, identify subpopulations most likely to benefit, and improve overall cost-effectiveness. Along with outcomes-based agreements, volume-based discounts will also be critical to provide expanded access for appropriate patients while addressing manufacturer concerns about recovering development and production costs while achieving a reasonable financial return, and payer and purchaser concerns that improved coverage will lead to large increases in spending.” Full

CMMI’s AI-Assisted Prior Authorization Model Becomes New Political Lightning Rod

(8/12, Christian Robles, Inside Health Policy) reports “...[Simeon Niles, a director at McDermott+,] told Inside Health Policy during a recent CMS call, some stakeholders expressed concerns that the WiSer model encourages companies to create algorithms that are more likely to deny prior authorization requests. The concern -- which Democratic lawmakers raised in their letter -- stems from the fact that the WiSer model will reimburse companies with a ‘percentage of the savings associated with averted wasteful, inappropriate care as a result of their reviews,’ according to CMS.” Subscription Required