“Determining the Value of Healthcare—A Multi-Stakeholder Perspective,” brought together experts in medicine, public policy, and business who are working to improve the nation’s healthcare system for both providers and patients alike.

In attendence were doctors and representatives from New York Presbyterian and Beth Israel hospitals, the fields of insurance, academia, medical device manufacturing, entrepreneurs, and information technology.

Presented by the Global Healthcare Innovation Management Center‘s EmblemHealth’s Value Initiative, the round table addressed three areas related to health outcome measurement and evaluations:

—Patient centered measurement of health outcomes;
—The overall value of evidence-based healthcare;
— Assessing the potential value of new health innovations.

Falguni Sen, Ph.D., director of the Global Healthcare Innovation Management Center, advocated looking beyond the notion of efficient and effective healthcare and embracing “the value of good health” even though the problem of measuring it would be difficult.

“The notion of good health varies from country to country, from sub community to sub community within the country, and its complexities from lifestyle and other socioeconomic factors get very difficult to capture,” he said.
“This is the objective we would like to work towards over the next few years.”

In his keynote address “State of Healthcare Reform,” Stuart Altman, Ph.D., professor of National Health Policy at Brandeis University, laid out the challenges that lie ahead, as the Affordable Care Act, widely known as “Obamacare,” goes into effect in 2014.

Because the law lies somewhere between a government-run single-payer system nor a privately-run voucher system, Altman said it’s not surprising that problems have arisen.

“In order to make it work, you’ve got to make it mandatory. If you’re going to make it mandatory, you have to make it fair. If you’re going to make it fair, it gets expensive,” he said. “And finally, if it’s really expensive, it requires government. There’s just no way around it.”

What is surprising though, two years after it’s passage polls show that only 42 percent of Americans think it will benefit the country. Some of that can be attributed to the fact that 85 percent of Americans will be largely unaffected by it because they already have some form of health insurance, he said.

One area that will require future attention is Medicaid. The U.S. Supreme Court allowed states to opt out of the expansion of Medicaid, even though, Altman noted, 50 percent of Americans who would be gaining insurance would be getting it from that program.

“We are not going to have universal coverage even if this works perfectly, because there are people that are going to fall through the cracks big time in some states,” he said.

Altman said that healthcare spending is expected to only grow by about $90 billion, or 2 percent of what the nation currently spends by 2019, and will reach 20 percent of our gross domestic product (GDP) by then.

The problem with attacking rising health care costs, he noted, is that all major health care groups would have opposed Obamacare if they were simultaneously tasked with providing universal coverage.

“It’s easy to dismiss it, but politically it is dynamite. So what the Obama people did was the same thing we did in Massachusetts, which is to say ‘Let’s deal with coverage first, and then let’s deal with health care second,’” he said.
“Cost containment, ultimately, is very important, but I think the government was right in not trying [to reduce spending]directly at that time, or we would have passed nothing,” he said.

Three decades ago, healthcare was practiced on a regional level and structured according to the unique cultural, political and economic factors that defined its region.

But that is a way of the past, said Joseph Pieroni, GSAS ’71, former president and CEO of pharmaceutical giant Daiichi Sankyo, Inc.

In his lecture “Changes in the Healthcare Environment: Move Toward Globalization,” delivered Dec. 8 at Fordham’s Rose Hill campus, Pieroni explained that the sharply rising cost of healthcare has forced the industry to expand beyond the regional level to operate in a multi-national market.

“In order to recoup the cost of development, global development and commercialization is a must,” Pieroni said.

A 40-year veteran of the pharmaceutical industry, Pieroni said that changing regulatory practices in drug manufacturing has placed a strain on research and development.

“The productivity of innovators is going down because of challenges with regulatory agencies,” he said. “Products that a few years ago would’ve cost $150 million to make now cost $600 million… I don’t think Advil and Tylenol would’ve been in our medicine chest in the current regulatory environment.”

In addition, the Drug Price Competition and Patent Term Restoration Act of 1984, commonly known as the Hatch-Waxman Act, amplified competition between brand name drugs and generics. Under Hatch-Waxman, pharmaceutical companies can market their brand drug exclusively only until its patent expires. Following that period, manufacturers can seek approval for a generic version that is biochemically equivalent to the brand drug. Once approved, generic manufacturers are permitted access to all data relating to the brand drug.

Since the 1984 bill, generic drugs have grown to occupy nearly 70 percent of the U.S. prescription market. As a result, Pieroni said, research and development has suffered. While the cost of drug development continues to increase, cheap generics, which can sell for 90 percent less than a brand drug, are dominating the market.

“It’s very difficult for a company to introduce a product that can meet that competition,” Pieroni said. “The enormous cost of discovering and developing innovative products is forcing smaller companies out. Only larger companies with global reach will survive.”

The situation is similar in other countries, he added, where brand drugs cost substantially less than even in the United States. Consequently, many foreign companies have increased their presence in the United States, where they can profit more, encouraging multi-country research and development. Both of these factors, Pieroni said, ultimately influence medical practices.

Pharmaceutical companies are not the only sector facing challenges, he pointed out. Because of the changing environment and rising costs of healthcare, all of the main constituents of the industry—providers, patients, payers, such as governments and private insurance companies, as well as pharmaceuticals—are feeling the strain.

“Healthcare cost is a huge burden to society,” Pieroni said. “Pressure is increasing on all stakeholders to contain costs… The model must change.”

What can be done to stem the rising cost of healthcare?

The event, “Healthcare Innovations: Bending the Cost Curve,” focused on the joint objectives of improving patient care and reducing the cost of delivering it.

Panelists included:

• Nancy Nielsen, M.D., of the Center for Medicare and Medicaid Innovation;
• Michael Dowling, CEO, Northshore LIJ Health System;
• Frank Branchini, president and COO, EmblemHealth;
• Jeffrey Spaeder, M.D., chief medical and scientific officer, Quintiles; and
• Jaime Torres, regional director, Region II, U.S. Department of Health and Human Services.

“We do not have terrific health outcomes in this country,” Nielsen said. “Part of that is due to lifestyle choices. On the other hand, there is something really very wrong with our system when we are spending so much more [than other nations]and getting so much less.”

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Panel members also spoke about the challenges facing the pharmaceutical industry given regulatory uncertainty, the high cost of end-of-life care and the implications of rolling out the Affordable Care Act.

Nielsen spoke about the pressing need to work together toward innovation, but also stressed that the interests of all parties must be addressed.

“It is really important that we lay down arms—not decide who is the enemy of the day. Instead, we should build bridges to try to figure out how to solve the gap that has been so well described as the quality chasm,” she said.

“None of us can do it alone. It is true that all of our industries are concerned about their well-being and sustainability. When something would threaten your economic well-being, you’re going to fight back,” she said.

Dowling said that from his perspective on the ground in a hospital, the healthcare situation is challenging, but not as bleak as the media may suggest.

“When you pick up the newspaper, you have an avalanche of negativity about healthcare in the United States. But there is also an awful lot of great stuff going on. There is a lot more in common between the various stakeholders than one would necessarily think,” Dowling said, referencing several of his fellow panel members.

The discussion marked the first public event hosted by Fordham’s Global Healthcare Innovation Management Center.

The multi-stakeholder panel was an example of how the center can have a significant impact on creating innovations in healthcare, according to Falungi Sen, Ph.D., founding director of the center and chair of the management systems area at the Fordham Schools of Business.

“The panelists aren’t people who regularly work together,” Sen said. “Yet they were very respectful of each other, pointed out their differences and conflicts, and didn’t get to any acrimony between the perspectives.”

Sen said he felt the event provided a significant first step in opening the kind of conversations that will move these issues forward.

“The event clarified in people’s minds what the key issues in our healthcare debate really are,” he said. “People have heard the issues before, but they have not understood them substantively,” he said.

More than 150 members of the healthcare industry from across the tri-state area attended the event.

Sen said the center plans to release a paper summarizing the panel’s discussion this fall.

– Jennifer Spencer

One of the nation’s leading medical school deans spoke frankly of the need for America’s future doctors to change course in practice and research, in order to sidestep a looming healthcare debacle.

Highlighting a Fordham University event on Oct. 6, Philip A. Pizzo, FCRH ’66, dean of Stanford Medical School and a practicing physician for nearly five decades, praised the funding of broad scientific research, which, he said, often leads to important medical discoveries with multiple applications.

Unfortunately, research innovation in the nation today is “shockingly limited,” he said. Many pharmaceutical companies have moved away from research and development altogether, while governmental agencies are tending to limit funding to application-based, or evidence-based, research alone.

“We in the United States are looking at a period coming when funding is going to be dramatically constrained,” said Pizzo, a Bronx native who earned degrees in philosophy and biology before entering medical school. “Fundamental discovery is important. If everything has to have an application, we are going to miss that critical insight that doesn’t yet have a fit.”

Dr. Pizzo gave as an example medical research on retroviruses—or RNA viruses—in the decades before HIV/AIDS began appearing in the population. Such completed research on retrovirus behavior, he said, made it all the more possible to develop critical AIDS treatments relatively quickly, staving off what could have been a major epidemic.

“New diseases will astound us,” Dr. Pizzo said. “But basic science and queries, unlinked to what we are facing today, could provide solutions to tomorrow’s problems.”

While the United States is a great nation—one that enabled Pizzo to be the first in his family to graduate from high school and college—its healthcare system based on a fee-for-service model is bankrupting the government. Currently, the U.S. spends a whopping 17 percent of Gross Domestic Product on health care, twice the amount of any other developed nation, and it is rising.

“We are not first in anything other than administrative overhead,” said Pizzo, noting that the nation’s costly and disproportionate healthcare system falls behind in both longevity and disease outcomes.

“We have embraced technology in ways that are overexhuberant, and they have increased the cost of care and created distance between physicians and those that they care for. It is all too easy to just order a test.”

Tomorrow’s doctors, said Pizzo, will have to fight the perception that being a good doctor means ordering test after test on patients. More emphasis, he said, should be placed on familiarizing themselves with patient histories, and looking at and listening to their patients.

“Strong science must have strong humanism,” he said.

The doctor credited his time at Fordham, where he studied science, philosophy and theology, with helping him frame the way he thinks about science today.

“I learned something more important (than science) at Fordham—critical thinking,” he said. “I learned to be reflective, to listen, and to continue to explore.

“Those skills are still inspiring today’s Fordham students.”

In addition to serving as dean, Dr. Pizzo is Stanford’s Carl and Elizabeth Naumann Professor of Pediatrics and Microbiology and Immunology. He has held positions at the National Cancer Institute and National Institutes of Health, and chaired Harvard Medical  School’s Department of Pediatrics from 1996 to 2001.

He is the author of more than 500 scientific articles and 15 books and has received numerous awards and honors for his work—including an honorary degree from Fordham.

Economist and award-winning journalist Maev-Ann Wren will present the lecture. Wren is a former reporter for the Irish Times and the author of Unhealthy State: Anatomy of a Sick Society (2003), a comprehensive analysis of Ireland’s healthcare service. Wren will sign copies of her book at 5 p.m. in the 12th-floor lounge.

The discussant for the lecture will be Dale Tussing, Ph.D., a Syracuse University economics professor.

DATE:        WEDNESDAY, APRIL 13
TIME:         6 P.M. (5 P.M. BOOK SIGNING)
PLACE:      12-FLOOR LOUNGE, LOWENSTEIN CENTER
113 W. 60TH STREET, NEW YORK, NY

The Fordham University Center for Ethics Education was created in 1999 to contribute to Fordham’s commitment to cultivating lifelong habits of critical thinking, moral reflection and articulate expression. The Center sponsors activities that provide students, faculty, professionals and the public with knowledge and skills to study, inform and shape a just society that nurtures the full-flourishing of peoples of diverse faiths and cultures.

Established in 1997, Fordham University’s Institute of Irish Studies is one of the premier centers of Irish cultural scholarship and research in New York City. With its innovative interdisciplinary courses and public programs, the Institute promotes scholarly interest in Irish history, society and culture, and serves as a springboard for undergraduate programs in Irish studies.