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Biomedical subjects

Gail R Wilensky

Publications and source records attributed to Gail R Wilensky.

At least 19 recordsLinked to original sources
PubMed2006

Gain sharing: a good concept getting a bad name?

The introduction of diagnosis-related groups (DRGs) created a clear misalignment between the incentives facing hospitals and those facing physicians. The interest in gain sharing that developed in the 1990s represented an attempt by physicians to extract and hospitals to offer some of the savings being produced by physicians. Advisory bulletins by the Office of Inspector General (Department of Health and Human Services) quickly put a stop to further interest in these strategies. Newer, narrowly defined types of gain sharing have been under consideration. More broadly defined strategies that will be tested under a new Centers for Medicare and Medicaid Services demonstration are more promising.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Developing a center for comparative effectiveness information.

Interest in objective, credible comparative clinical effectiveness information has been growing in the United States, both by those who support competitive behavior in health care and by those who support administered pricing. The Medicare drug benefit has heightened interest in better information, although the potential payoff is even greater for medical procedures than for drugs, since procedures account for more of the health care dollar. Careful consideration needs to be given regarding the appropriate structure, placement, financing, and function of an agency devoted to comparative effectiveness if it is to achieve its objective: a mechanism to support better decision making in health care.

Cost-Benefit Analysis↗
PubMed2005

Alternative strategies for Medicare payment of outpatient prescription drugs--Part B and beyond.

Reimbursement options for pharmaceuticals reimbursed under Medicare Part B (physician-dispensed drugs) are changing and the new comprehensive Part D Medicare outpatient drug benefit brings further changes. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaces traditional policy, of reimbursing Part B drugs at 95% of average wholesale price (AWP, a list price), with a percentage markup over the manufacturer's average selling price; in 2005 an indirect competitive procurement option will be introduced. In our view, although AWP-based reimbursement has been fraught with problems in the past, these could be fixed by constraining growth in AWP and periodically adjusting the discount off AWP. With these revisions, an AWP-based rule would preserve incentives for competitive discounting and deliver savings to Medicare. By contrast, basing Medicare reimbursement on a manufacturer's average selling price undermines incentives for discounting and, like any cost-based reimbursement rule, may result in higher prices to both public and private purchasers. Indirect competitive procurement for drugs alone, using specialty pharmacies, pharmacy benefit managers, or prescription drug plans, is unlikely to constrain costs to acceptable levels unless contractors retain flexibility to use standard benefit management tools. Folding Part B and Part D into comprehensive contracting with health plans for full health services is likely to offer the most efficient approach to managing the drug benefit.

Ambulatory Care↗
PubMed2004

Bush versus Kerry: the healthcare philosophy debate.

With Washington and the rest of the country well into the political season and the candidates (not yet officially designated at the time of this writing) speaking around the country with increasing frequency, it is hardly surprising that health care is once again a favored topic of political conversation.

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