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Alzheimer's patients are in limbo as hospitals, insurers weigh Aduhelm


Adobe
For all the explosive controversy over the approval of the first treatment for Alzheimer’s disease in nearly 20 years, hardly any patients have actually gotten it yet.
The drug’s eye-popping, $56,000 annual price and questionable benefit to patients have been a shock to the bureaucracy that makes the health care system run and that’s having a clear effect on uptake. Some analysts estimated last month that fewer than 100 patients were dosed in the first weeks after the therapy was approved, though availability will likely ramp up over the coming months.
Though the Food and Drug Administration said in approving the therapy, Aduhelm, that the data indicate a likely benefit, hospital and insurer committees are conducting their own analyses, acting as another set of gatekeepers. They regularly review new treatments, but the lingering questions about the drug’s efficacy, as well as the logistical challenges of delivering an infused drug, are complicating and ....

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Former CMMI head launches value-based primary care start-up


Modern Healthcare Illustration / Getty Images
Independent Health pays providers for patient outcomes, not by how many people primary care clinicians get to walk through their front door.
In the four years since the insurer implemented its primary care capitated payment program, the Buffalo, New York-based health plan has moved 630 clinicians to accept a 10% up-and-downside adjustment for effectively managing 20,000 patients health. Providers like the program because it allows them to tailor their practice offerings and stay financially afloat when patients skip visits during the COVID-19 pandemic. Independent Health benefits from clinicians increased focus on preventative care, which decreases members hospital and emergency department stays and lowers overall costs, CEO Dr. Michael Cropp said. ....

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