Event

The US healthcare system is a hybrid system that provides access to care via various channels and means. It can be categorized as: governmental systems (Medicare, Medicaid, Veterans Health Administration, and Department of Defense, etc), private markets (privately sponsored regional and national health plans), and providers assuming responsibility for access and coverage via mechanisms such as Provider Networks, Integrated Delivery Networks (IDNs), Accountable Care Organizations (ACOs), etc. These elements are quite heterogeneous and characterized by different coverage and access mechanisms.

This introductory course will cover the roots of the current US healthcare system, its evolutionary process, and the consequent independence of these different parts of the system. The focus will be on value and affordability of pharmaceuticals as defined by cost, access, and quality. While all hold value and affordability as important goals, the different stakeholders take various perspectives and define these goals differently. This results in different objectives, incentives, and principles under which they operate.

The intent of this course is to better understand characteristics of the different parts of the US healthcare system and the role of various decision makers within it. The course will cover their structure, scope, processes, and perspectives as well as their approach to balancing access, costs, and quality considerations for pharmaceuticals. The course will also cover how industry and others produce evidence to support access and reimbursement decisions how the evidence is used by decision makers, and what decisions will be affected by Medicare drug price negotiation and the Inflation Reduction Act. This session will facilitate the increased level of understanding of these disparate systems and emphasize the need to effectively communicate evidence to various access decision makers to support and enhance evidence driven decision making on value and affordability of prescription drugs and biologics.

This course is designed for those having limited experience in understanding the structure of the US healthcare system, including its various subsystems and how they operate. The course will focus on how these entities differ in perspectives, coverage mechanisms, and the means and evidence they use to define and achieve both value (access and quality) and affordability.

Faculty