Treatment algorithms

Inside Edge Consulting, Princeton

January 29, 2015

Having focused on managed care organizations for the last four years and the insights provided by their decision makers, I have been struck by the overwhelming skepticism which surrounds the data and information that pharmaceutical manufacturers provide to managed care organizations. A healthy dose of skepticism does not hurt, however, especially when it is in pursuit of ensuring that all the information is provided in an appropriate context and applicable to specific patient subsets.

The real question that has been proposed within the last few years is how does managed care and pharmaceutical manufacturers work better together to share information, resources, or other tools from which they all can benefit? Managed care plans cover many lives across the country but they are most interested in specific regions or patient types that reflect the highest numbers of users of their plans. Pharmaceutical manufacturers are interested in drug revenues across the whole population and their slice of the market share pie. This creates the conundrum that we currently have: pharmaceutical manufacturers create tools to measure outcomes and impact on the total population and managed care organizations want to know how the drug benefits specific types of patients and regions of patients.

The feeling overall is that manufacturers will present data that make their drugs look best, and do not want to give away ‘secret equations’ behind the data being presented. There is nothing more that the managed care organizations want than the secret equations; they want to incorporate their data into these equations to understand whether results would be different. How do we get these two organizations to agree on how things are calculated?

In a previous post we discussed organizations like ACC/AHA or ASCO being responsible for determining value, but this is again just another opinion being put into the mix. This brings us no closer to what we want to do, which is treat patients better (quality and quantity of life) for less cost — because groups cannot agree on the best way to measure this. As we move into 2015, we need to again take a critical eye and look at the challenge from all perspectives to allow:

  • Patients to receive the best treatment
  • Payers to reduce the cost impacts of treatments to the system
  • Providers to make the most educated treatment solutions
  • Caregivers/families to have their loved ones around for the longest, healthiest lives they can have
  • Manufacturers to have enough money to continue to develop new treatments


How do we develop treatment algorithms for stakeholders that have different interests but rely on the other for their information? We have a chicken and the egg scenario with no answer in sight…

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