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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

Data Drives Insight into Value-based Care Decisions

by Anne Meneghetti, MD, Executive Director of Medical Information, Epocrates

How many times have you experienced the angst of finding out that a patient never filled a prescription because of personal finances? How often have you seen a patient go without treatment while prior authorization hurdles were being worked out? Practices are spending more time than ever before on affordability issues like these.

We recently surveyed 70 clinicians about their biggest affordability challenges. Topping their list of responses was the lack of available information on actual drug or procedure costs for patients, cited by 43% of respondents, while patient inability to afford care was listed second, by 28% of those surveyed.

In Jonathan Bush’s provocative new book, “Where Does It Hurt? An Entrepreneur’s Guide to Fixing Health Care,” the athenahealth CEO advocates for greater freedom to choose one’s own care options based on cost-effectiveness and personally meaningful differentiators. Yet without reliable insights into the specific costs and multi-dimensional outcomes for various options, neither clinicians nor patients are positioned to make clear choices.

Thankfully, guidance is emerging from multiple sectors.

The Patient-Centered Outcomes Research Institute (PCORI) was authorized by Congress to fund comparative effectiveness research to drive informed care decisions. A viewpoint piece in the June issue of the Journal of the American Medical Association (JAMA) calls upon specialty societies, such as the American Academy of Family Physicians (AAFP) and American College of Physicians, to create and disseminate specialty-specific tools and guidelines that help clinicians make complex value-based decisions. Specialty society guidance has also emerged from the American Board of Internal Medicine’s Choosing Wisely® Campaign, which encourages professional organizations to spark conversation between providers and patients about the value of various tests and treatments. For example, AAFP has suggested guidelines on when to question antibiotics for sinusitis or otitis media, and when to reconsider routine screening with PSA, DEXA, carotid artery stenosis testing and Pap smears. The American Academy of Pediatrics recommends criteria for routine CTs for minor head injury, simple febrile seizures, and abdominal pain. In addition, the organization offers advice on use of antibiotics for asymptomatic bacteriuria, cough and cold medicines for children under four years old, and GERD medications for “happy-spitter” infants.

Epocrates is doing its part to help bring clinical intelligence to the exam room to support value-based prescribing decisions. Within our core app, you can find hundreds of health plan and retail pharmacy formularies. Select “Alternatives” to compare affordability of other options in the same therapeutic subclass. Search the “Manufacturer/Pricing” section for a comparison between retail costs and formulary coverage; in some cases, retail pricing may be the most affordable choice.

The increasing focus on comparative effectiveness research, guidance from specialty societies, and cost data integrated into medical apps like Epocrates, will offer clinicians relevant insights for making complex value-based decisions of care.

What are your biggest pain points in identifying and obtaining affordable options for patients?

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