July 2014 Newsletter


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THE VIEW FROM HERE: New Hepatitis C Drug, Old Problems

Christopher F. Koller, President of the Milbank Memorial Fund

Every once in a while, an issue comes along that serves up so clearly the conflict between a societal desire to maximize medical care treatment choices and the reality of limited resources that people say, "Maybe this is the one that will provoke the hard conversations."

Enter Sovaldi for the treatment of Hepatitis C.

In the US, about 2.7 to 5.2 million people have Hepatitis C, a chronic disease that can take 20 to 30 years to progress, ultimately resulting in cirrhosis for 5% to 20% of patients and death for 1% to 5%. Sovaldi (sofosbuvir) is the first in a class of direct acting antivirals to be approved by the FDA as safe and effective for the treatment of Hepatitis C. There is, however, evidence assembled by the Center for Evidence-based Policy (CEbP) at Oregon Health & Science University that Sovaldi's manufacturer, Gilead, submitted limited results from a small body of research to obtain approval from the FDA under a "breakthrough drug" approval track that places greater priority on bringing drugs to market than on demonstrating safety and efficacy.1

The kicker? Gilead, sufficiently convinced of the drug's superiority to other treatments, has attached a price of over $80,000 for the twelve-week course of treatment, which is about $1,000 per pill (if you are keeping track). Gilead based this price on... READ MORE

June Issue of THE MILBANK QUARTERLY Makes Headlines

The lead article in the June issue of The Milbank Quarterly attracted attention around the world. Its focus was on previously secret documents that revealed that Big Tobacco had a long-standing interest in getting into the "pot" business. As a result of litigation against the tobacco industry, more than 80 million pages of internal company documents had become available at the University of California San Francisco's Legacy Tobacco Documents Library. Led by Stanton A. Glantz, PhD, Director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, the study was the first to systematically review these documents specifically about marijuana.

The study was covered in the Los Angeles Times, Time, The Independent, Chicago Tribune, news outlets in Greece and Finland, and many others. See the June press.

New Issue Brief: Collaboration for System Improvement—Aligning Quality Measures Across Payers and Providers

In our multi-payer health care system, administrative simplification and performance improvement can be elusive goals. Now, in some health care markets around the nation, public and private payers are considering ways to align activities to help providers weary of complexity deliver more efficient, higher quality care. But where to start? How to build consensus? How to collaborate and not compete?

With support from the Milbank Memorial Fund, the Center for Health Care Strategies (CHCS) explores options for synchronizing quality measurement agendas across public and private payers and providers in a new Issue Brief. The Issue Brief draws from the innovative efforts of three states—Maine, Vermont, and Wisconsin—as they outline strategies for multi-payer alignment. The lessons about coordinating quality measures can inform efforts at payer alignment in other activities as well. Read the Issue Brief.

Christopher Koller Contributes to White House Report

The President's Council of Advisors on Science and Technology (PCAST) of the White House's Office of Science & Technology Policy released a report on May 29 entitled "Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering."

The report, according to PCAST, "identifies a comprehensive set of actions for enhancing health care across the nation through broader use of systems-engineering principles. Informed by the deliberations of a working group consisting of PCAST members and prominent health-care and systems-engineering experts, the report proposes a strategy that involves: (1) reforming payment systems, (2) building the nation's health-data infrastructure, (3) providing technical assistance to providers, (4) increasing community collaboration, (5) sharing best practices, and (6) training health professionals in systems engineering approaches."

"This report highlights the importance of primary care transformation," says Christopher Koller, who was a member of the PCAST working group. "There findings are consistent with what we're learning about primary care transformation in the 17 states within the Multi-State Collaborative." The Multi-State Collaborative is a group of states supported by the Milbank Memorial Fund that have come together to share data and learn from one another about primary care transformation.

About the Milbank Memorial Fund

The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience. Founded in 1905, the Fund engages in nonpartisan analysis, collaboration, and communication on significant issues in health policy. It does this work in three ways: publishing high quality, evidence-based reports, books, and The Milbank Quarterly, a peer-reviewed journal of population health and health policy; convening state health policy decision makers on issues they identify as important; and building communities of health policymakers to enhance their effectiveness. www.milbank.org.


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