Glaucoma 360: Fostering innovation in the face of costs, policy issues

Patients and physicians alike clearly benefit from innovations in treatment. However, the conundrum is clear: how can innovation continue to be fostered in the face of health policy issues and economics?

“This is the reality in which we live,” said David W. Parke II, MD, CEO of the American Academy of Ophthalmology.

Dr. Parke delivered the Drs. Henry and Frederick Sutro Memorial Lecture titled, “When Cost and Innovation Collide in Ophthalmology” at the Glaucoma 360 annual meeting in San Francisco.

The importance of this in today’s political environment cannot be over emphasized. Health care is the No. 1 or No. 2 issue for voters and more specifically the cost of health care. It is probably the single issue in Washington, D.C., on which both parties are united, Dr. Parke pointed out. But this is where the picture gets muddied a great deal. Concerns about cost do not involve one drug or device but affects everything in health care and for every practice in ophthalmology.

“The bottom line is that if cost limits the clinical impact of innovation, then it limits innovation itself,” Dr. Parke said.

Policy perspective

The goals from a health care policy perspective is reduction of costs for patients and society and improved access to quality care. But is this possible to achieve all when considering the exponential increases in the average annual costs of care/patient over the past 40 years and the one third increase in copayments in the United States in about three years in the US where the country’s health care costs far exceed those of every other country?

A domino effect is apparent: increased costs have real societal effects; treatments cost more than patients, employers, and taxpayers can afford; medication adherence decreases and nonadherence costs billion in avoidable health care costs. And innovation has been shown in multiple economic studies to be the major force in cost increases, not increased productivity on the part of the physicians and their increased revenue.

“The economics are complex,” Dr. Parke said. “The health care market is inefficient, and Medicare seems to be a maze of inequalities in drug pricing and valuing of services.”

A prime example was a 15% decrease in cataract surgery payment because of the effect of endocyclophotocoagulation, a glaucoma procedure, on the reevaluation of the entire family of codes.

“This is an example of the intersection of innovation and cost,” he noted.

New pricing approaches are being looked at with an eye toward value-based pricing, in which the pricing is linked to the value achieved by a new drug; indication-specific pricing is another avenue of consideration, that is, when a drug or device is indicated for treatment of two diseases and achieved better results in one disease, the pricing potentially may change accordingly.

AAO’s role

“The organization acts as an advocate for patients and the profession and by extension we are advocating for innovation,” Dr. Parke said.

AAO provides clinical guidelines for quality care and recently the IRIS registry, which is the first comprehensive eye disease clinical registry, has been providing great insights into real-world evidence from data derived from more than 75 million patient records from more than 18,000 physicians. It is an ideal database for glaucoma with data from over 5 million glaucoma patients and glaucoma suspects.

The extensive data provides the basis for forming policy and analyzing decisions. Dr. Parke concluded with the recognition that cost and innovation collide.

“It is our role as experts in the professional community and industry to help to try to reconcile and move the models forward,” he concluded. “Some market regulation always will be required and we will be moving to some form of value-based practice and the perfect value-based pricing has yet to be described. We are all going to benefit from more granular data on processes and outcomes so that we can get to a sustainable equilibrium that rewards innovation and ultimately moves our profession forward.”