Using telemedicine interventions during COVID-19 to expand care post COVID-19.

Despite available technology and supportive evidence in the literature, the integration of telemedicine interventions in the US health care system has remained sluggish for decades. The COVID-19 pandemic catalyzed widespread utilization of virtual visits and remote monitoring in urgent, primary, and specialist care settings out of sheer necessity. Specifically, in the rheumatology subspecialty, a lack of available providers and a patient community hindered by mobility and access issues have underscored the value of telemedicine. For these reasons, a solutions-focused, multistakeholder virtual roundtable meeting convened by the Frances Hamburger Institute for Community Rheumatology (FHI) identified telemedicine as a critical area for intervention to improve the quality and cost-effectiveness of patient-centered care. Building upon stakeholder experience and published findings, the Patient-Centered Rheumatology Collaborative identified the continued deregulation of policy barriers and the facilitation of sustainable coverage and reimbursement as critical steps toward establishing a robust infrastructure for telemedicine post pandemic. FHI roundtable attendees acknowledged several remaining telemedicine access barriers concerning traditionally underserved patient populations that will need to be addressed to realize the full potential of telemedicine. These recommendations are in concordance with those of other recent consensus groups, and they legitimize the formation of collaborative frameworks among payers, providers, and other key stakeholders to advance care in rheumatology.

Comparative mutant analyses reveal a novel mechanism of ARF regulation in land plants.

A major challenge in plant biology is to understand how the plant hormone auxin regulates diverse transcriptional responses throughout development, in different environments, and in different species. The answer may lie in the specific complement of auxin signaling components in each cell. The balance between activators (class-A AUXIN RESPONSE FACTORS) and repressors (class-B ARFs) is particularly important. It is unclear how this balance is achieved. Through comparative analysis of novel, dominant mutants in maize and the moss Physcomitrium patens , we have discovered a ∼500-million-year-old mechanism of class-B ARF protein level regulation, important in determining cell fate decisions across land plants. Thus, our results add a key piece to the puzzle of how auxin regulates plant development.

Provider and patient insights into the cancer care journey.

OBJECTIVES: To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning. STUDY DESIGN: We conducted a cross-sectional survey of primary care providers (PCPs) and insured patients with cancer. METHODS: We asked PCPs about their method of oncologist referral; utilization of an oncologist selection tool that directs patients to high-quality, high-value oncologists; involvement in cancer care and value-based care; and when an advance directive should be established. We asked patients to reflect upon their personal experience when selecting their oncologist, utilization of an oncologist selection tool, and establishing an advance directive. RESULTS: PCPs tend to refer patients to oncologists who are part of their health system (67.9%). Most PCPs (79.2%) were not currently utilizing an oncologist selection tool; most (77.3%) expressed a willingness to use such a tool. Most PCPs (69.8%) believe the best time to talk about an advance directive is at the time of cancer diagnosis. Patients ranked a PCP referral (52.7%) as "very important" when selecting an oncologist. One-third of patients used a web-based oncologist selection tool; 65.2% responded that an oncologist selection tool would be "somewhat" or "very" important. Most (54.5%) patients had an advance directive. CONCLUSIONS: These results present a compelling rationale for developing a data-driven oncologist selection tool, optimizing patient and provider involvement in care, and expanding the portion of patients who have an advance directive at the start of their cancer care to optimize their cancer journey.

Managing the cost drivers of medical injectables.

In recent years, the cost increases of medical injectables--pharmaceuticals and apparatus used to treat rare and chronic diseases--have far outstripped the rises in medical costs in general. Health plans have taken notice, and many are designing and implementing new procedures for managing these treatments. The task is complex and challenging, but identifying and addressing the cost drivers and, in particular, creating specialty pharmacy networks, hold the promise of containing the spiraling cost of medical injectables.

Curbing the costly trend: exploring the need for a progressive approach to the management of specialty pharmaceuticals under the medical benefit.

BACKGROUND: Specialty injectables and protein-based biologic therapies represent the fastest growing segment of the drug trend for many plan sponsors. Coupled with the decline in spending on traditional pharmaceuticals and so-called blockbuster drugs coming off patent, the upward trend of specialty drug spending continues at an unprecedented rate, precipitating a shift in the focus of payers who manage prescription drugs. OBJECTIVES: To characterize the current and future specialty drug spending and describe contemporary trends among payers for managing cost and quality in this segment, as well as to elucidate the shortcomings of the current efforts and to explore a comprehensive approach for addressing the cost and quality concerns directly associated with specialty injectables and protein-based biologics through interrelated management interventions. DISCUSSION: Although a notable decrease in spending on traditional pharmaceuticals was realized in 2010, disproportionate increases in specialty drug utilization and cost per unit fueled the continuing growth of the injectable and biologic markets. Each course of these therapies can cost in the tens of thousands of dollars, and this upward trend of specialty spending represents an escalation of an already significant spending for payers, employers, and members. Beyond the high cost and growing utilization of specialty pharmaceuticals, current management efforts have been met with variable degrees of success and have often proved challenging and, in some cases, even counterproductive. Common interventions used by payers nationwide for addressing specialty drug spending trend include specialty drug formularies, provider reimbursement strategies, distribution channel management, benefit design modifications, utilization management, and operational and administrative improvements such as postclaim edits. Although often overlooked, appropriate implementation of these tactics, and the extent to which they are integrated with overall drug benefit management, are key to the success of the pharmaceutical management program. CONCLUSION: Conventional specialty pharmaceutical management initiatives offer promise in various areas, but incentives for the best protocols may be misaligned when they are applied individually. Conversely, a comprehensive approach that integrates effective components of the specialty pharmaceutical management interventions can improve the quality of care and control costs associated with these agents, with significant specialty drug management expertise and access to benchmarking data serving as the foundation for appropriate decision-making.