Manatt A U.S. Perspective Commonwealth Fund Alliance for Health Reform November 7, 2011 Ian D. Spatz.

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Presentation transcript:

manatt A U.S. Perspective Commonwealth Fund Alliance for Health Reform November 7, 2011 Ian D. Spatz

Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

45.23 liters Liters Liters 8.96 Liters Source: 2009 Wine Institute Wine Consumption Liters

Source: FAOstat (UN) Beer Consumption liters Liters liters liters liters

Obesity 9.4% 12.9% 23% 30.6% Source: OECD Health Data 2005 Percentage of population with BMI>30

CT Scan Abdomen $179 $374 $187 $536 Source: International Federation of Health Plans, 2010 (U.S. avg.)

Bypass Surgery $16,325 $27,327 $ $59,770 Source: International Federation of Health Plans, 2010 (U.S. avg.)

Cost Effectiveness

Comparative Effectiveness

Cost Effectiveness Comparative Effectiveness Patient-Centered Outcome Research

Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

Large, Empowered Payers Express Scripts CVS/Caremark Germany France Medco UK MedImpact 90 million 85.1 million 81.5 million 65 million 63 million 32 million Atlantic Information Services, 2010

Multi-tier formularies Generic substitution Prior authorization Generics first Drug utilization review Risk sharing

Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data

“Whether the addition of [product] to chemotherapy regimens for [type of cancer] improves health outcomes has not been established.” “It was not certain whether [product] provides enough benefit to patients to justify its high cost …, so NICE did not recommend it.” “We don’t know” “We know it doesn’t help”

Starting in 2013, Medicare and all private health insurance companies will pay a tax into a trust fund that will support the activities of the Patient-Centered Outcomes Research Institute Funding is estimated to reach $500 million annually by 2015

Points to make The U.S. is Different Search for Value Already Underway in U.S. Success Depends on Investment in Generating Data, Not Just Analyzing Data