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

Currently SVP of Oncology and Specialty Market Programs at Aventria Health Group.  Formerly was  CCO 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 "The question is how, as a Health System, we're going to be able to manage that." 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 "Buy and Bill." 06:30 The potential for Providers to make a significant portion of their income from purchasing more expensive products. 07:00 Medicare's 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 "As long as the Pathways reflect the Gold Standard." 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's 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.