rhonda simoff - Academia.edu (original) (raw)

Papers by rhonda simoff

Journal of Clinical Oncology, 2013

273 Background: Clinical pathways are a growing payer management technique for controlling costs ... more 273 Background: Clinical pathways are a growing payer management technique for controlling costs and standardizing care. Their use in other therapeutic areas has helped payers control costs and standardize care; however, use of pathways in oncology has not been assessed. Methods: There were a total of 49 respondents, including 19 Medical Directors and 30 Pharmacy Directors, covering 100 million lives in the US across all channels (Medicare, Commercial, and Medicaid). Approximately 39% of respondents were from small plans (covering less than 750,000 lives), 28% were from medium-sized plans (covering 750,000 – 2.5 million lives), and 33% of respondents represented large plans (covering more than 2.5 million lives). About 33% of respondents were from national plans, while 67% were from regional plans. Results: Only 39% of payers have actually implemented pathway programs in oncology. Of the payers surveyed that did not already have a clinical pathway, 59% said they are not currently im...

American Journal of Managed Care, Dec 13, 2013

American health & drug benefits, 2010

Obesity is an increasing problem in the United States, and the health problems attributed to it h... more Obesity is an increasing problem in the United States, and the health problems attributed to it have a significant economic impact on the healthcare system, as well as on patients' quality of life. In addition, childhood obesity is increasingly becoming a prominent diagnosis. To identify physician and payer reactions to the profiles of 4 new obesity products in development and the potential that these will be prescribed by physicians and reimbursed by payers. This article examines payers' and physicians' perspectives in effective treatment options for this epidemic. A 2008 online survey conducted by Reimbursement Intelligence was completed by 42 physicians who are advisors to Pharmacy & Therapeutics Committees and see an average of 435 obese patients monthly, as well as 17 payers who represent more than 100 million covered lives. This research was double blinded to conceal product and client identification. Qualitative and quantitative data were collected from the survey...

American health & drug benefits, 2012

Cancer care in the United States is being transformed by a number of medical and economic trends,... more Cancer care in the United States is being transformed by a number of medical and economic trends, including rising drug costs, increasing availability of targeted therapies and oral oncolytic agents, healthcare reform legislation, changing reimbursement practices, a growing emphasis on comparative effectiveness research (CER), the emerging role of accountable care organizations (ACOs), and the increased role of personalization of cancer care. To examine the attitudes of health plan payers and pharmacy benefit managers (PBMs) toward recent changes in cancer care, current cost-management strategies, and anticipated changes in oncology practice during the next 5 years. An online survey with approximately 200 questions was conducted by Reimbursement Intelligence in 2011. The survey was completed by 24 medical directors and 31 pharmacy directors from US national and regional health plans and 8 PBMs. All respondents are part of a proprietary panel of managed care decision makers and are m...

American health & drug benefits, 2012

Advances in therapies for rheumatoid arthritis (RA), particularly biologics, have transformed the... more Advances in therapies for rheumatoid arthritis (RA), particularly biologics, have transformed the treatment paradigm for RA. However, the associated costs of these therapies result in a significant economic burden on the healthcare system. As a chronic disease requiring lifelong treatment, most health plans now position RA drugs as a high-priority therapeutic category. To identify provider and payer practices and perceptions regarding coverage of RA biologics in the current marketplace, as well as emerging trends in reimbursement practices. In November 2011, Reimbursement Intelligence, a healthcare research company, collected and analyzed quantitative and qualitative data via parallel-structure online surveys of 100 rheumatologists and 50 health plan payers (medical and pharmacy directors) who represent more than 80 million covered lives. The surveys included approximately 150 questions, and the surveys were designed to force a response for each question. Payers reported using tier ...

Managed care (Langhorne, Pa.), 2002

Managed care (Langhorne, Pa.), 2002

You think patient satisfaction with the health system is marginal in the doctor’s office after a ... more You think patient satisfaction with the health system is marginal in the doctor’s office after a decade of managed care? Welcome to the pharmacy counter. Perhaps nowhere can the ire of the consumer be seen and heard more clearly than where prescription drugs are sold. It is here that customers may find either satisfaction or annoying hassle. And there can be direct links between the drugstore experience and the health of the patient, as well as his satisfaction with the full health care plan.

Journal of Oncology Practice, 2014

To operate under a new value-based paradigm, oncology providers must develop the capability to ag... more To operate under a new value-based paradigm, oncology providers must develop the capability to aggregate, analyze, measure, and report their value proposition-that is, their outcomes and associated costs. How are oncology providers positioned currently to perform these functions in a manner that is actionable? What is the current state of analytic capabilities in oncology? Are oncology providers prepared? This line of inquiry was the basis for the 2013 Cancer Center Business Summit annual industry research survey. This article reports on the key findings and implications of the 2013 research survey with regard to data analytic capabilities in the oncology sector. The essential finding from the study is that only a small number of oncology providers (7%) currently possess the analytic tools and capabilities necessary to satisfy internal and external demands for aggregating and reporting clinical outcome and economic data. However there is an expectation that a majority of oncology providers (60%) will have developed such capabilities within the next 2 years.

Journal of Oncology Practice, 2013

Over the past year, both the volume and intensity of concern about the unsustainable growth of ca... more Over the past year, both the volume and intensity of concern about the unsustainable growth of cancer care costs have mounted steadily. Oncology clinical pathways, once widely disdained as "cookbook medicine," are being adopted through successful payer-provider collaboration and provider compliance with pathways that generally exceed early expectations. 1,2 Emerging in parallel with clinical pathways are new cancer care delivery models, notably accountable care organizations (ACOs), that are striving for sustainable cost and quality balance through better coordination of care and more effective integration of palliative care. Reimbursement Intelligence (RI), a market access consulting firm, recently completed a survey with medical and pharmacy directors from 49 leading payer organizations, representing more than 100 million covered lives (Table 1). The goal of the survey was to gain a better understanding of how payers are initiating or collaborating with providers to implement costmanagement and delivery models.

Journal of Medical Marketing, 2010

Abstract The article evaluates the recent challenges faced by the pharmaceutical industry and the... more Abstract The article evaluates the recent challenges faced by the pharmaceutical industry and the impact of those challenges on the product development process. Upon identification of key hurdles faced by the pharmaceutical companies during the development process, ...

American health & drug benefits, 2011

Diabetes and its clinical consequences exact a great toll on patients and on society in terms of ... more Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests th...

American health & drug benefits, 2013

Oncology practices are seeking to adapt to new care delivery models, including accountable care o... more Oncology practices are seeking to adapt to new care delivery models, including accountable care organizations (ACOs), patient-centered medical homes (PCMHs) in oncology, and oncology pathways, as well as new payment models, such as bundled payments or pay-for-performance contracts. Our survey sought to determine which payment models and care delivery models payers view as the most viable and the most potentially impactful in managing and reducing the cost of cancer care. We conducted an online national survey of 49 payers, including 19 medical directors and 30 pharmacy directors, representing more than 100 million covered lives within national and regional plans, using a validated instrument comprised of approximately 120 questions. The survey was administered using the SurveyGizmo website. It was initiated on July 10, 2012, and completed on July 25, 2012. The survey included open- and closed-ended questions and probed payers about models of care that they, in collaboration with pro...

Journal of Clinical Oncology, 2013

273 Background: Clinical pathways are a growing payer management technique for controlling costs ... more 273 Background: Clinical pathways are a growing payer management technique for controlling costs and standardizing care. Their use in other therapeutic areas has helped payers control costs and standardize care; however, use of pathways in oncology has not been assessed. Methods: There were a total of 49 respondents, including 19 Medical Directors and 30 Pharmacy Directors, covering 100 million lives in the US across all channels (Medicare, Commercial, and Medicaid). Approximately 39% of respondents were from small plans (covering less than 750,000 lives), 28% were from medium-sized plans (covering 750,000 – 2.5 million lives), and 33% of respondents represented large plans (covering more than 2.5 million lives). About 33% of respondents were from national plans, while 67% were from regional plans. Results: Only 39% of payers have actually implemented pathway programs in oncology. Of the payers surveyed that did not already have a clinical pathway, 59% said they are not currently im...

American Journal of Managed Care, Dec 13, 2013

American health & drug benefits, 2010

Obesity is an increasing problem in the United States, and the health problems attributed to it h... more Obesity is an increasing problem in the United States, and the health problems attributed to it have a significant economic impact on the healthcare system, as well as on patients' quality of life. In addition, childhood obesity is increasingly becoming a prominent diagnosis. To identify physician and payer reactions to the profiles of 4 new obesity products in development and the potential that these will be prescribed by physicians and reimbursed by payers. This article examines payers' and physicians' perspectives in effective treatment options for this epidemic. A 2008 online survey conducted by Reimbursement Intelligence was completed by 42 physicians who are advisors to Pharmacy & Therapeutics Committees and see an average of 435 obese patients monthly, as well as 17 payers who represent more than 100 million covered lives. This research was double blinded to conceal product and client identification. Qualitative and quantitative data were collected from the survey...

American health & drug benefits, 2012

Cancer care in the United States is being transformed by a number of medical and economic trends,... more Cancer care in the United States is being transformed by a number of medical and economic trends, including rising drug costs, increasing availability of targeted therapies and oral oncolytic agents, healthcare reform legislation, changing reimbursement practices, a growing emphasis on comparative effectiveness research (CER), the emerging role of accountable care organizations (ACOs), and the increased role of personalization of cancer care. To examine the attitudes of health plan payers and pharmacy benefit managers (PBMs) toward recent changes in cancer care, current cost-management strategies, and anticipated changes in oncology practice during the next 5 years. An online survey with approximately 200 questions was conducted by Reimbursement Intelligence in 2011. The survey was completed by 24 medical directors and 31 pharmacy directors from US national and regional health plans and 8 PBMs. All respondents are part of a proprietary panel of managed care decision makers and are m...

American health & drug benefits, 2012

Advances in therapies for rheumatoid arthritis (RA), particularly biologics, have transformed the... more Advances in therapies for rheumatoid arthritis (RA), particularly biologics, have transformed the treatment paradigm for RA. However, the associated costs of these therapies result in a significant economic burden on the healthcare system. As a chronic disease requiring lifelong treatment, most health plans now position RA drugs as a high-priority therapeutic category. To identify provider and payer practices and perceptions regarding coverage of RA biologics in the current marketplace, as well as emerging trends in reimbursement practices. In November 2011, Reimbursement Intelligence, a healthcare research company, collected and analyzed quantitative and qualitative data via parallel-structure online surveys of 100 rheumatologists and 50 health plan payers (medical and pharmacy directors) who represent more than 80 million covered lives. The surveys included approximately 150 questions, and the surveys were designed to force a response for each question. Payers reported using tier ...

Managed care (Langhorne, Pa.), 2002

Managed care (Langhorne, Pa.), 2002

You think patient satisfaction with the health system is marginal in the doctor’s office after a ... more You think patient satisfaction with the health system is marginal in the doctor’s office after a decade of managed care? Welcome to the pharmacy counter. Perhaps nowhere can the ire of the consumer be seen and heard more clearly than where prescription drugs are sold. It is here that customers may find either satisfaction or annoying hassle. And there can be direct links between the drugstore experience and the health of the patient, as well as his satisfaction with the full health care plan.

Journal of Oncology Practice, 2014

To operate under a new value-based paradigm, oncology providers must develop the capability to ag... more To operate under a new value-based paradigm, oncology providers must develop the capability to aggregate, analyze, measure, and report their value proposition-that is, their outcomes and associated costs. How are oncology providers positioned currently to perform these functions in a manner that is actionable? What is the current state of analytic capabilities in oncology? Are oncology providers prepared? This line of inquiry was the basis for the 2013 Cancer Center Business Summit annual industry research survey. This article reports on the key findings and implications of the 2013 research survey with regard to data analytic capabilities in the oncology sector. The essential finding from the study is that only a small number of oncology providers (7%) currently possess the analytic tools and capabilities necessary to satisfy internal and external demands for aggregating and reporting clinical outcome and economic data. However there is an expectation that a majority of oncology providers (60%) will have developed such capabilities within the next 2 years.

Journal of Oncology Practice, 2013

Over the past year, both the volume and intensity of concern about the unsustainable growth of ca... more Over the past year, both the volume and intensity of concern about the unsustainable growth of cancer care costs have mounted steadily. Oncology clinical pathways, once widely disdained as "cookbook medicine," are being adopted through successful payer-provider collaboration and provider compliance with pathways that generally exceed early expectations. 1,2 Emerging in parallel with clinical pathways are new cancer care delivery models, notably accountable care organizations (ACOs), that are striving for sustainable cost and quality balance through better coordination of care and more effective integration of palliative care. Reimbursement Intelligence (RI), a market access consulting firm, recently completed a survey with medical and pharmacy directors from 49 leading payer organizations, representing more than 100 million covered lives (Table 1). The goal of the survey was to gain a better understanding of how payers are initiating or collaborating with providers to implement costmanagement and delivery models.

Journal of Medical Marketing, 2010

Abstract The article evaluates the recent challenges faced by the pharmaceutical industry and the... more Abstract The article evaluates the recent challenges faced by the pharmaceutical industry and the impact of those challenges on the product development process. Upon identification of key hurdles faced by the pharmaceutical companies during the development process, ...

American health & drug benefits, 2011

Diabetes and its clinical consequences exact a great toll on patients and on society in terms of ... more Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests th...

American health & drug benefits, 2013

Oncology practices are seeking to adapt to new care delivery models, including accountable care o... more Oncology practices are seeking to adapt to new care delivery models, including accountable care organizations (ACOs), patient-centered medical homes (PCMHs) in oncology, and oncology pathways, as well as new payment models, such as bundled payments or pay-for-performance contracts. Our survey sought to determine which payment models and care delivery models payers view as the most viable and the most potentially impactful in managing and reducing the cost of cancer care. We conducted an online national survey of 49 payers, including 19 medical directors and 30 pharmacy directors, representing more than 100 million covered lives within national and regional plans, using a validated instrument comprised of approximately 120 questions. The survey was administered using the SurveyGizmo website. It was initiated on July 10, 2012, and completed on July 25, 2012. The survey included open- and closed-ended questions and probed payers about models of care that they, in collaboration with pro...