Leaders from both parties, including President Donald Trump, House Speaker Nancy Pelosi, and many Democratic presidential hopefuls, have discussed plans on how to address these costs. 

In the wake of all the conversation surrounding the issue, two Gabelli School of Business professors—Falguni Sen, Ph.D., who heads the Gabelli School’s Global Healthcare Innovation Management Center, and Navid Asgari, Ph.D.—decided to make drug pricing a focus for the center this year.

One of their first events will be a panel and conversation titled “Facts and Myths in Drug Pricing,” to be held at Fordham Law School on Monday, Oct. 28, from 6 to 8 p.m., with a reception to follow.

All those who need at least one prescription are affected by this issue, Sen said.

“The whole issue is one of affordability—access to medicine and affordability of medicine; they’re highly related,” he said. “Access is, is there enough quantity right now available for us to get to distribution centers that will allow us to have it and prescription systems that will allow people who need it to get it? Then comes the whole question of affordability. Unless pricing changes, affordability does not change.”

One of the goals of the forum, he said, is to highlight the complexities surrounding drug pricing. The cost of new, innovative drugs and their high rate of failure can cause a legitimate increase in drug prices, Sen said, but the lack of regulation in the current system can allow those prices to increase exponentially.   

“Is it just our market system, where we do not do what the rest of the world does, where there is some kind of a reference pricing that is done?” he said. “Is that the reason for what is happening with pricing, or is it fear that some new kind of ‘local therapies’ are going to come into play so pharma better make all its money very quickly, before all those alternatives come in … We need to put all these things out on the table and have a proper discussion about it.”

The event will feature keynote speaker John LaMattina, Ph.D., of PureTech Health, who spent 30 years working at Pfizer, one of the largest pharmaceutical companies. 

“I’m quite sure for him the facts and myths are going to be different than the facts and myths of other people, so we wanted a panel that would present the different points of view,” Sen said.

The panel will include Sen, Asgari, and Will Mitchell, Ph.D., of the Rotman School of Management at the University of Toronto, all of whom come at the issue from a different perspective. 

Based on Mitchell’s previous work, Sen said he expects him to provide a “down-the-middle” approach, highlighting the importance of maintaining innovation but also keeping costs down when appropriate.

“I personally come a lot more from the public health and the public good space, which is that drugs, especially life-saving drugs, should be easily available,” Sen said. “I feel that our prices in the U.S. are very, very high, mainly because of the fact that they are free-market pricing and whatever the market can bear, as opposed to really related to cost.”

The event is free and open to the public. Register here.

Harding, a native of Idaho who graduated from Fordham College at Rose Hill in 2018 with a degree in communication and media studies, said the film inspired to pursue her current career.

“I was interested in the power of positivity. I knew I didn’t want to do anything clinical; I don’t think I have the doctor personality in me. But I knew I wanted to help people, and I knew I wanted to work with kids,” she said.

As a care coordinator at the Memorial Sloan Kettering Cancer Center, Harding assists children who need procedures such as bone marrow biopsies. In that role, she said, she constantly utilizes the skills she learned as part of the inaugural cohort of Fordham’s master’s degree in health administration.

“In my department, I am trying to make sure our patients not only have a wonderful patient experience, but I’m also thinking of the procedures. In my department, I have to know what codes to use for billing, and I have to know the ethics behind the children going under anesthesia,” she said.

“All of these things are in the back of my mind while I’m at work, and I learned all of that through my introductory course to health care.” The course is one of 17 courses that comprise the program.

An Industry With Potential

As one of 17 students to sign up for the degree, which is hosted in the Graduate School of Arts and Sciences and taps the expertise of faculty from the across the university, Harding was exposed to all the facets of an industry that is estimated by the Center for Medicare and Medicaid Services to comprise more than one-sixth of the American economy.

It’s an industry that’s in great flux as well. On Sept. 10, the Census Bureau reported that about 27.5 million people, or 8.5 percent of the U.S. population, lacked health insurance for all of 2018, up from 7.9 percent the year before. It was the first increase in uninsured Americans since the Affordable Care Act passed in 2010.

Falguni Sen, Ph.D., a professor of business at the Gabelli School of Business who heads the program and the Gabelli School’s Global Healthcare Innovation Management Center, said that instability was exactly what the program was designed to address.

“Students told us the program really prepared them to address the challenges that the Affordable Care Act had brought into the health care industry, in terms of integrated care, the importance of prevention in primary care, and looking at the patient as a whole person,” he said.

“They’ve been given the tools where they can identify and create solutions to new problems as they come up.”

A Diverse Cohort

A second-year cohort has already admitted 19 students, and except for a small change to one course to help students better use data, the coursework is the same.

Although all students admitted to the program were required to show that they had a passion for the field consistent with the Jesuit tradition of service for others, Sen noted that differences among the members of the cohort were important too. Not everyone was a recent college graduate like Harding.

“We had members of the group who have been in the medical profession for more than 30 years. They shared information and opportunities with each other, and we see that reflected in the types of new jobs and promotions that these students have ended up getting,” he said.

Jeffrey Moskowitz, M.D., a medical review officer at Con Edison who earned a doctorate of medicine in 1977, was one of them. One of his previous jobs was as an administrator of a large outpatient surgery center, and he said he wanted to learn more about how larger trends in the health care field affected his work.

“My perspective on the field has totally changed. The only thing I knew was what I had personally seen. Here, we got a world viewpoint, which was much greater than anything I’d known before,” he said.

“This was an eye opener in terms of how things work on different levels—not just on a practitioner level, but the hospital level, the lab level, and how government policy affects everything.”

Focusing on Patients, Not Paperwork

For his capstone project, Dr. Moskowitz designed a wellness program for ConEd focused on preventing employees from getting sick. In terms of coursework, he noted that courses on marketing and ethics were particularly useful.

“We reviewed how to look at situations from various viewpoints and make reasonable decisions while keeping moral and ethical thoughts in mind, which is really what health care administration should be about,” he said.

“If the focus is the patient, and nothing is black and white, how do you best choose among the different options? I liked that ethics course a lot.”

And while it’s true that the Affordable Care Act has ceased to continually increase the number of Americans with health insurance, other changes that it inspired live on, he said.

“One of the modern revolutions in health care is actually listening to the patient. Traditionally health care revolved around what worked for the doctor, which is why most health care is delivered between 9 and 5, when it’s inconvenient for people to get there,” he said.

“Now many hospitals now have patient experience coordinators, and Medicare is reimbursing doctors based in part on patient surveys. This was all brought out in terms of the course.”

That renewed focus on patients is evident in the way the degree is structured, he said.

“As a Jesuit university, Fordham cares a lot about people,” he said.

“So it makes sense that this degree is about keeping people healthier, rather than just the simple administration of rules and regulations that help an institution make money.”

The answer lies in innovation, according to a group of industry experts who spoke at a May 7 event at Fordham’s Lincoln Center campus titled “Transforming Employer-Provided Health Plans: Innovating for Patient-Centered Value.”

Falguni Sen, director of Fordham’s Global Healthcare Innovation Management Center, which hosted the event, framed the extraordinary scale of the challenge in his introductory remarks.

“We are going to try to the impossible,” he said. “Making health care better than it is by changing the nature of both affordability and access.”

Rapidly rising health care costs have impacted health benefits in a number of ways that often leave both employers and employees dissatisfied, Sen said. This often results in narrower provider networks, more frequent billing, and recurrent claims disputes, among other issues.

“Employers want their employees to be healthy and their costs to be lower,” Sen said. “Employees want their employers to be successful, but not at the cost of lowering their health care benefits.”

Sen and an expert panel of health care industry leaders explored innovative ideas that will help achieve these twin goals during a wide-ranging discussion that drew heavily on the panelists’ real world application of novel and effective techniques.

Mitra Behroozi, executive director of Benefit and Pension Funds for 1199SEIU, the largest health care workers union in the U.S., illustrated how health care plans can harness “the power of zero” to deliver exceptional service at an exceptional value.

The nearly 400,000 members covered by the union’s benefit funds pay nothing toward their premiums and are responsible for no co-pays, coinsurance, or deductibles when following plan rules. But despite the extremely rich benefits enjoyed by members, the funds’ costs are well below both regional and national averages on a per worker basis.

Behroozi, who co-moderated the panel with Sen, explained that while some employers have directed rising costs to workers in the form of deductible and premium increases, the 1199SEIU Benefit Funds have taken an alternate approach.

“When you engage in extreme cost shifting, patients avoid needed care as well as unneeded care,” she said, continuing, “Our cost-containing principles are to maintain the availability of quality care and avoid financial barriers for our members.”

1199SEIU’s example demonstrates that quality benefits don’t necessarily have to come with high premiums and out-of-pocket expenses, she said, if plans are designed to incentivize choices that reduce overall costs.

“Our opportunity when we design benefits is to make it simple for people to use the highest-value things and to avoid the lowest-value things,” Behroozi said.

Claire Levitt, the deputy commissioner of the New York City Mayor’s Office of Labor Relations, shared her public sector perspective on how the city achieved $3.4 billion in health care cost savings that were used to fund wage increases for municipal employees.

One crucial step taken by the city, Levitt explained, was to begin collecting data on patient care costs, which had never been gathered before due to privacy concerns. Guided by this information, the city began adjusting beneficiaries’ out-of-pocket expenses to encourage preventive care and reduce the number of cost-driving visits to urgent care and emergency rooms.

Michael Chernew, the Leonard D. Schaeffer Professor of Health Care Policy at Harvard Medical School, drew on his experience both as a health economist and as chair of the university’s benefits committee. He noted that employers must consider not only insurance carriers’ costs, but also how the services available through their plans will accommodate employees’ needs. “You want to look for a carrier that can manage the care and has relationships with the delivery system,” Chernew said.

Tom Traylor, general manager of pharma solutions at the Health Transformation Alliance, explained how his company identifies high-value providers and treatments through data and analytics. The Health Transformation Alliance is owned by 50 blue-chip companies, each of which share health care data that can be leveraged to compare outcomes and produce better results for all of the 4.5 million individuals covered under the employers’ plans.

He detailed how thoughtfully constructed prescription drug formularies can drive patients toward high-efficacy drugs and exclude low-value, high-cost drugs.

“Just because the FDA approved it does not necessarily mean that it provides any additional value,” Traylor said. “You can have a drug that is one to two percent better or worse but 20 percent more expensive, and it’s in a category where there are drugs already available. Why have that drug available?”

While it is difficult to predict possible policy changes and technological developments that will help shape the future of American health care, Sen said, the innovations discussed by the panel will have a major role to play.

“In the next few years we are going to really see major changes in the way health care is delivered and paid for,” he said.

Sen quoted a remark his co-moderator Behroozi made to him about the task putting into motion the changes that will drive this transformation: “The main innovation lies in making innovation happen.”

— Michael Garofalo

The APA division examines psychological theories and their “relevance for scientific and pragmatic applications,” said Morrissey, adding that most members of the group come from academia. She said her main focus will be to “push the boundaries” and nudge the group toward “scholar activism.”

“I see health as the whole being,” said Morrissey, who will be teaching a course on patient-centered care in Fordham’s master’s program in health administration this spring. “We need to ask how we’re designing research and translating it into the field in a way that gives voice to marginalized people.

Part of the way she is hoping to turn theory into action is through collaborations with fields beyond psychology.

She noted that the recent refugee crisis in the U.S., which has split up families impacted people fleeing violence, represents an opportunity for research that will not only help future refugees, but provide important evidence to back up potential policy changes. The effort also brings the society in conversation with nine other APA divisions, she said, as well as many organizations outside APA such as community advocacy groups.

“The exciting thing about this kind of work is that it expands the network beyond the academic community of psychologists so that we’re working closely with social workers, attorneys, ethicists and other APA colleagues,” said Morrissey.

This isn’t to say that practical applications will usurp the group’s mission to advance theory, she said. Rather, immersion in practice—action in the field—will help develop theory.

One example of theoretical work being advanced by the society focuses on dementia, she said. She noted that many healthy people view the experience of those who have dementia as totally negative, an assumption she believes should be challenged.

“We need to engage in more reflective dialogue to do a better job of understanding the lived experience of people with dementia, such as, are they experiencing any joy?” she said. “They may also have a certain type of agency that we don’t understand. We need to challenge assumptions to understand the diversity of their experience better. Here there are also big implications for policy and advocating for a workforce that is equipped to care for people with dementia.”

Another aspect within dementia research that pushes theoretical boundaries is the practice of using personal experience with loved ones as narrative evidence.

“We’re rejecting rigid boundaries between subject and object,” she said, of the practice. This is in contrast to traditional practice, where researchers in psychology generally keep their subjects at arm’s length, lest the work be tainted by familiarity.

“It’s a type of qualitative position to disclose that I have written about my own mom,” she said, referring to Mary Ann Quaranta, Ph.D., former dean of the Graduate School of Social Service, who lived through serious illness near the very end of her life.

“I lived with both my grandmother and my mother through their experience with later-life changes and illness, and I draw on those perspectives in my own research in gerontology,” she said.

“As a qualitative practice, I disclose my positionality, my own experience and perspective, and that’s not viewed as a burden,” she said, though she acknowledges this approach is contested by some.

“It may yield insights about dimensions of the subject’s world that until now remained elusive.