BCHT Presentations

Background image: library

Reference Pricing

Prices paid for the same services vary significantly even within the same market yet, consumers often lack access to information about price and quality when seeking medical care, and providers are not required to justify higher prices with evidence of better quality. Reference pricing can motivate providers to compete based on price as well as quality, and to pursue cost-reducing innovations. The Berkeley Center for Health Technology (BCHT) conducts reference pricing research in order to identify and refine methods to control health care spending while insuring access and quality.

RESEARCH     PUBLICATIONS

 

PRESENTATIONS

Pharmaceutical Reference Pricing.  Employer Summit, sponsored by Northeast Business Group on Health and Commonwealth Fund.  New York City, 10.12.18.

Reference Pricing for Drugs and Diagnostic Tests.  MCOL Webinar, 10.05.18.

Reference Pricing as a Purchaser Strategy.  National Coalition on Health Care, California Public Employees Retirement System conference on California health system innovation.  Sacramento, CA 09.12.18.

Reference Pricing as an Employer Strategy to Promote Patient Choice of Freestanding Surgical and Diagnostic Centers.  California Ambulatory Surgery Association, annual conference, Long Beach, CA 09.07.18.

Reference Pricing as an Employer Strategy for Managing Costs.  Webinar.  American Academy of Actuaries.  07.09.18.

Reference Pricing, Value-based Pricing, and Value-based Access for Pharmaceuticals.  Adaptive Health, San Francisco, CA 04.11.18.

Reference Pricing, Value-based Pricing, and Value-based Access for Pharmaceuticals.  America’s Health Insurance Plans (AHIP) Policy Conference, Washington DC, 03.08.18

Reference Pricing in Insurance Design: Surgery, Diagnostics, Drugs.  National Pay-for-Performance Summit, San Francisco, CA 03.01.18.

Reference Pricing as a Purchaser Strategy for Managing Drug Prices.  Board of Directors, California Public Employees Retirement System, Petaluma CA 01.17.18.

Reference Pricing as a Purchaser Response to High and Rising Pharmaceutical Prices.  Webinar.  Pacific Business Group on Health, 11.10.17.

Reference Pricing Changes the Choice Architecture of Health Care.  California Public Employees Retirement System.  Sacramento, CA.  04.05.17.

Reference Pricing: Impacts to Date, and Potential Extension to Drugs, 3.19.17

Reference Pricing for in vitro Laboratory Tests, 2.2.17

Reference Pricing in Health Insurance, University of Utah, Department of Economics.  Salt Lake City, UT.  08.29.16.

Pricing and Patient Access: Strategies and Negotiations between Payers and Pharmaceutical Firms in the US,  Roche Group, Italy.  Milan, Italy.  06.30.16.

MORE

Cost-based, Value-based, and Reference-based Pricing for Diagnostics,  International Society for Pharmacoeconomics and Outcomes Research (ISPOR), annual European conference, workshop on economics of diagnostics, Milan, Italy November 8, 2015.

Value Purchasing in Orthopedics: Price Transparency, Bundled Payment, and Reference Pricing. American Association of Orthopedic Surgery (AAOS), conference on value health care.  Washington DC, May 2014.

Reference Pricing as an Employer and Insurer Strategy for Cost Control. James Robinson. National Institute for Health Care Management; Webinar onPayment Reform: State and Private Sector Innovations; August 16, 2012.

Kaiser Permanente: Southern California Permanente Leadership Conference. James Robinson. City of Industry, California, July 16, 2012.

Consumer Cost Sharing: The Ranges of Alternatives. James Robinson.Aligning Payment Reform and Benefit Design. Kim MacPherson. Additional presentations by Aldo de la Torre and Brad Wolfsen(link is external)Pay for Performance Summit(link is external)Mini-Summit III: Insurance Benefit Design and Cost Sharing for Payment Reforms; March 20, 2012.

Consumer Cost Sharing and Use of High-Cost Biopharmeucticals. James Robinson. California Public Employees Retirement System (PERS); Pension and Health Benefits Committee. Sacramento, California. March 13, 2012.

Pricing and Access for Pharmaceuticals

The prices for drugs and biologics are interpreted in quite different ways by policymakers and by innovators. For policymakers whose principal concern is patient access and affordability, prices for drugs and biologics are simply too high. And for those whose principal concern is supporting research and innovation for unmet health care needs, prices for drugs and biologics are not high enough or, at least, are in need of additional support to sustain R&D.  Both sides agree that the price of individual products should be better aligned with the value of extended life and reduced suffering they offer to patients, and to society at large by way of increased productivity and reduced downstream expenditures. They also agree that a willingness by pharmaceutical firms to moderate prices should be matched by a willingness of insurers to reduce barriers to patient access, in the form of physician prior authorization and consumer cost sharing requirements.

BCHT is pursuing a range of research projects and professional educational activities related to value-based pricing and patient access, including innovative and value-based pricing, physician payment methods for drug-related services, insurance benefit designs, and the application of reference pricing to drugs.

RESEARCH     PUBLICATIONS

 

PRESENTATIONS

Sustaining R&D in the US Pharmaceutical Market.  Roche Pharmaceuticals, Monza, Italy.  01.17.20.

Evolution of Pharmaceutical Price Negotiations and Outcomes in the United States.  Bocconi University, Milan Italy.  01.08.20.

US Payer Strategies for Managing Drug Prices, and Implications for Sustaining Research and Innovation,  14thAnnual French-American Seminar on Economics and Politics of Health. Organized with University of Strasbourg and ESSEC School of Business.  Paris, France 12.18.19.

Accelerating Adoption and Competition for Biosimilars,  Paris School of Economics.  Paris, France.  12.17.19.

Management of Expensive Drugs by US Insurers and Physician Organizations, Medix Switzerland.  Zurich, CH. 12.12.19.

Price Compression in the US Pharmaceutical Market: Options for Manufacturers, Payers, and Policymakers, Novartis Pharmaceuticals, Madison NJ. 11.14.19.

Value In HealthCare: Employer Strategies to Engage Employees, MemorialCare Presidential Partnership Conference, Costa Mesa CA, 030819, James C. Robinson

The Rapidly Changing Competitive Landscape of Biopharma.  Leerink Annual Global Healthcare Conference, New York, 02.27.19.

Contracting for Value-based Price and Value-based Access for Specialty Drugs.  13th Annual French-American Seminar on Economics and Politics of Health.  University of Paris, University of Strasbourg.  Paris France 12.12.18.

The New US Landscape in Market Access, Pricing, Provider Prescription, and Consumer Engagement.  French High Authority for Health (HAS), Committee on Economic Evaluation and Public Health.  Paris, France 12.11.18.

“Demonstrating the Value of Innovation: Meeting the Evidentiary and Economic Needs of FDA, Payers, Providers, Consumers.”  Varian Medical Systems, Executive Leadership Retreat, Palo Alto, CA 10.26.18.

New Drug Pricing Structures to Support Innovation and Affordability.  Novartis Pharmaceuticals, Morristown NJ 09.17.18.

Alternative Funding Mechanisms for Pharmaceutical Innovation, Policy Roundtable.  Laura and John Arnold Foundation.  Washington DC 09.13.18.

Incentivizing R&D through Innovation Prizes, James C. Robinson

Role of Competition in the US Pharmaceutical Market.  Spain Affiliate, Roche Pharmaceuticals, Madrid, Spain 05.18.18.

Role of Market Competition in the HTA Process: Perspective from the US Market, MORSE Academy on Health Technology Assessment, Roche Pharmaceuticals, Basel Switzerland, 05.15.18.

Two-Part Drug Pricing to Promote Access and Innovation in the United States. Universities of Paris, Strasbourg, and California-Berkeley, annual Paris conference of biopharmaceutical policy.  Paris, France 12.13.17.

Purchaser and Policy Strategies for Managing Specialty Pharmaceuticals in the United States, IGES, Berlin, 12.7.17

Purchaser and Policy Strategies for Managing Specialty Pharmaceuticals: Research at UC Berkeley. Institute for Healthcare Management, Technical University Berlin, 12.05.17

Public and Private Payer Responses to Pharmaceutical Pricing in the United States. Webinar.  Colorado Business Group on Health, 11.21.17.

Pharmaceutical Industry Challenges in the US: Pricing and Patient Access, Mayer, Japan, 10.17.17

Paying for Precision Medicine. Precision Medicine Leaders Summit, San Diego, CA.  08.23.17.

Orphan Diseases Or Population Health? Policy Choices Drive Venture Capital Investments. Dayton Misfeldt and James C. Robinson, Health Affairs Blog,(link is external)(link is external) July 21, 2017

Payer Options for Managing Specialty Drugs, The National Institute for Health Care Management (NIHCM), 5.12.17

Reference Pricing for Drugs, 5.9.17

Pharmaceutical Reference Pricing in Health Insurance, 1.15.17

MORE

Public and Private Payer Responses to Pharmaceutical Prices in the United States,  BNP Paribas, Atelier (roundtable for pharmaceutical executives).  University of Glasgow, Institute of Health and Wellbeing. Glasgow, UK.  09.27.16.

Public and Private Payer Responses to Pharmaceutical Pricing in the United States, Glasgow, 8.10.16

Mobile Technology as a Platform to Support Price Transparency. University of Paris-Descartes, Faculty of Pharmacy, colloquium on digital health.  Paris, France, May 28, 2015

Biomedical Innovation in the Era of Health Care Spending Constraints, James Robinson. Health Affairs, Press Briefing, Washington DC, February 5, 2015

Promoting Innovation and Affordability in Health Care. East Bay Leadership Council, annual conference on health care.  San Ramon, CA September 25, 2015

Biomedical Innovation in an Era of Health Care Cost Restraint. Health Affairs.  Press Briefing, Biomedical Innovation.  Washington DC, February 5, 2015.

Public and Private Health Insurance Pricing for Innovative and Expensive Drugs in the U.S. James Robinson. University of Paris, Department of Pharmacy and Biologics, Colloquium on Value-based Pricing, Paris December 10, 2014.

Innovation and Affordability in Biomedical Technology. James Robinson.UC Berkeley Homecoming 2012; April 21, 2012.

Evolution of Insurer Strategies for Managing Biopharmaceuticals in the U.S. James Robinson. Current State and Future Outlook for Pharmaceutical Risk Sharing Agreements. Kim MacPherson. University of Paris Descartes. Seventh Annual University Descartes-Evry-Berkeley Colloquium; May 24, 2012.

John Muir Hospital and Warner Pacific Health Services; Health Care Reform Summit. James Robinson. Walnut Creek, California; April 24, 2012.

Price Transparency and Value-Based Purchasing in Health Services. National Business Coalition on Health: Annual Conference; February 16, 2012.

Managing Biopharmaceuticals in the Private Health Sector. Centers for Medicare and Medicaid Services, Region IX; June 23, 2009.

Comparative Effectiveness Research: Clinical Evidence and Economic Incentives. 5th Seminar of Economic Themes of Health; Paris, France; May 27, 2010.

Health Financing Reform in the United States: Overview and Implications for the Pharmaceutical Industry. James Robinson. 5th Seminar of Economic Themes of Health; Paris, France; May 27, 2010.

Managing Biopharmaceuticals in the U.S. — Public Policy and Market Strategy. University of Paris, Faculty of Pharmacy; Paris, France; May 13, 2009.

Value-Based Health Care: The Role of Pharmaceuticals. Foundation for Managed Care Pharmacy; February 4, 2009.

December 2014: University of Paris, JC Robinson.  Public and Private Health Insurance Pricing for Innovative and Expensive Drugs in the U.S.

December 2014: Roche, Basel Switzerland., JC Robinson.  Challenges and Opportunities Facing the US Biopharmaceutical Industry.

.

Drug Assessment and Pricing in Germany

As the United States looks for new ideas on pharmaceutical reform, it is instructive to look at drug assessment and pricing in Germany, a prosperous nation that features universal coverage, a private multi-payer health insurance system, a large pharmaceutical industry, and drug prices that are lower and more directly linked to clinical benefit than those in the US. BCHT Director James Robinson has been studying the German system with support of the Commonwealth Fund, combining site visits with econometric analyses of the structure, processes, and outcomes of the German system.

RESEARCH     PUBLICATIONS

 

PRESENTATIONS

Clinical Assessment and Price Determination in the German Pharmaceutical System.  Webinar, Novartis Pharmaceuticals.  01.29.20.

Developments in the US Pharmaceutical Market.  Roche Pharmaceuticals, German Affiliate, Grenzach, DE 05.28.19.

An American in Berlin: Insights on Drug Assessment and Pricing under AMNOG.  German Managed Care Association, Berlin, DE 05.23.19.

Demonstrating the Value of Innovation: Meeting the Needs of FDA, Payers, Providers, Consumers.  University of Strasbourg, FR 05.16.19.

Challenges and Strategies for the Medical Device Industry in the US: Potential Implications for the EU.  Corvinus University, Department of Economics, Budapest, HU 03.26.19.

Medical Devices

Implantable medical devices, ranging from artificial knees to cardiac pacemakers to deep brain stimulators, offer substantial benefit to patients and value to society.  This clinical and social value depends, however, on the high quality but affordably priced devices being used on the appropriately selected patient, by an experienced surgeon, and in the least costly site of care.  Over the past ten years BCHT has conducted a series of quantitative and qualitative studies of device assessment, pricing, and utilization, with the results disseminated through peer-reviewed journal articles, Issue Briefs and journalistic reports, and presentations at professional, governmental, and scholarly conferences.  Some of the key findings of the research were brought together in a book, Purchasing Medical Innovation, published by the University of California Press in 2015.

RESEARCH     PUBLICATIONS

 

PRESENTATIONS

MedTech Innovation Amid Changing Market Dynamics. Stasbourg, 5.16.19

Demonstrating the Value of Innovation: Meeting the Needs of  FDA, Payers, Providers, Consumers, Strasbourg, 5.16.19

Consumerism Comes to Orthopedic Surgery.  Hospital for Special Surgery, New York, 02.28.19.

Role of Market Competition in the HTA Process: Perspective from the US Market.  MORSE Academy on Health Technology Assessment, Roche Pharmaceuticals, Basel Switzerland, 05.15.18.

Role of Market Competition in the HTA Process: Perspective from the US Market, MORSE, Basel, 5.3.18

MedTech Innovation Amid Changing Market Dynamics.  NexFlex, FHE Forum.  Palo Alto, CA.

MedTech Innovation Amid Changing Dynamics for Physicians, Hospitals, and Consumers. University of Texas, Dell School of Medicine, Austin TX.  06.23.16.

Life Sciences Innovation Amid Changing Market Dynamics.  Luncheon investor meeting, Barclays Equity Analysis, New York, March 24, 2016.

MORE

Purchasing Medical Innovation: Price Transparency, Bundled Pricing, and Reference Pricing. James Robinson. AMD3 Foundation annual Value in HealthCare Conference, Duquesne Club, Pittsburgh, PA February 13, 2015

MedTech Innovation Amid Changing Dynamics for Insurers, Hospitals, and Consumers.  Keynote address to Deutsche Bank MedTech Bootcamp, Boston, March 21, 2013.

Purchaser Initiatives to Improve Value for Spine Surgery. Integrated Healthcare Assocation; October 25, 2010.

Improving Value for Medical Devices. Hospital Association of Southern California; April 17, 2009.

Value Purchasing in Orthopaedics. American Academy of Orthopaedic Surgeons; February 25, 2009.

Pursuing Value for Medical Devices in Orthopaedics. University of California, San Francisco Department of Orthopaedics; October 22, 2008.

Value-Based Purchasing of Drugs, Biologics, and Medical Devices. America's Health Insurance Plans; June 19, 2008.

Pursuing Value for Medical Devices: Hospitals and Manufacturers. Integrated Healthcare Association / California Hospital Association Conference; May 21, 2008.

.

Provider Payment and Consumer Benefit Design

Hospitals increasingly are purchasing physician practices and employing individual physicians as part of their strategy to evolve into fully integrated health systems.  This consolidation offers the potential for improvements in care coordination and efficiency, but also the risk of increased pricing power and organizational complexity.  This study uses 2013-14 claims data from Anthem Blue Cross of California, covering all commercially insured enrollees in the firm’s PPO products, to examine the cost of care incurred by patients treated by hospital-affiliated physicians in comparison to costs incurred by patients treated by physicians not employed by hospital-owned medical groups and practices.  The total cost of care per patient is measured using claims for ambulatory, hospital, pharmaceutical, and ancillary clinical services.  This study also examines selected measures of clinical quality, which vary by specialty.  Data were obtained from Anthem. This study is funded by the California Public Employee Retirement System (CalPERS).

RESEARCH     PUBLICATIONS

 

PRESENTATIONS

Physician Organization Relations with Insurers: Quality Improvement and Cost Management, Medix Guest Symposium, Zurich, CH. 12.13.19.

Structure and Payment Methods for Physician Organizations in the USA, Medix Guest Symposium, Zurich, CH.  12.13.19.

Physician-Led Organization: Developing and Capturing Competitive Advantage, OptumCare California, Physician Leadership Summit.  Dana Point, CA. October 19, 2019.

Re-Stimulating Health Care Competition.”  California Public Employee Retirement System (CalPERS), board meeting, Rohnert Park, CA 01.22.19.

Insurers, Hospitals, and Consumers: Challenges for IPAs.  OptumCare, North American Medical Management physician leadership summit, Dana Point, CA 10.21.18.

Paying for Personalized Value: Perspective of the Payers, 8.23.17

High-Deductible Health Plans: Impacts on Health Care Use, Price, and Value, 7.20.17

Navigating the Future Impact of Value-Based Pay in DiagnosticsBarclays Equity Analysis Diagnostics Symposium. New York, NY. April 21, 2017

Navigating the Future of Value-Based Payment in Diagnostics.  Deutsche Bank MedTech Bootcamp.  Washington DC.  03.30.17.

Navigating the Future of Value-Based Payment in Diagnostics. Q1 Productions, 10th Annual Conference on Diagnostic Coverage and Reimbursement.  San Diego, CA.  02.09.17.

MORE

Hospital Consolidation: the good, the bad, and the backlash.  Keynote address to Manhattan Institute conference on hospital market power, Harvard Club, New York City, March 23, 2016.

MedTech Innovation Amid Changing Dynamics for Physicians, Hospitals, and Consumers. University of Texas, Dell School of Medicine, Austin TX.  06.23.16.

Life Sciences Innovation Amid Changing Market Dynamics. Barclays Equity Analysis, New York, NY.   03.24.16.

Physician-Hospital Consolidation: The Good, the Bad, the Solution.  Healthcare Association of Southern California, Annual Conference.  Carlsbad, CA, April 23, 2015.

Impact of Increasing Consumer Cost Sharing on Physician Organizations: The Good, the Bad, and the Inevitable. James Robinson. University of Pittsburgh Medical Center, UPMC Health Plan, annual conference, Pittsburgh, PA October 28, 2014

U.S. Experience with Physician Payment Reform: Implications for U.K. Commissioning. Keynote address by James Robinson to King's Fund Conference, Payment Reform: Moving beyond Payment by Results (link is external)(link is external)(link is external). Dr. Robinson's slides are available, as are video highlights of histalk.

MedTech Innovation Amid Changing Dynamics for Insurers, Hospitals, and Consumers.   Deutsche Bank MedTech Bootcamp, Boston, 03.21.13

"Innovation in Physician Payment and Organization for Cancer Care" presentations and audio from the BCHT webinar held on November 28, 2012, which focused on an innovative pilot between Wellpoint and Wilshire Oncology on an oncology medical home.

  • Presentation by James C. Robinson, PhD, Leonard D. Schaeffer Professor of Health Economics, University of California at Berkeley; Director, Berkeley Center for Health Technology
  • Presentation by Linda D. Bosserman, MD, FACP, Medical Oncologist and President, Wilshire Oncology Medical Group, an Affiliate of US Oncology
  • Presentation by Jennifer Malin, MD, PhD, Medical Director Oncology, WellPoint, Inc., Thousand Oaks
  • Presentation by Kimberly MacPherson, MBA, MPH, Program Director, Health Policy and Management, University of California at Berkeley; Co-Director, Berkeley Center for Health Technology
  • Webinar Recording [~10MB .mp3 file]

American Academy of Orthopedic Surgery Annual Conference; Session on Measuring Quality and Value in Orthopedic Surgery. James San Francisco. February 10, 2012.

Price Transparency and Value-Based Purchasing in Health Services.National Business Coalition on Health: Annual Conference; February 16, 2012.

Health Plan Strategies for Controlling Health Care Costs. James Robinson. California Health Benefits Exchange; Board of Directors Meeting and Public Forum; February 21, 2012.

Explaining Hospital Prices and Profits : Medicare Cost Shifting or Market Concentration? Academy Health Annual Research Meeting; June 29, 2010.

Comparative Effectiveness Research: Clinical Evidence and Economic Incentives. 5th Seminar of Economic Themes of Health; Paris, France; May 27, 2010.

Health Financing Reform in the United States: Overview and Implications for the Pharmaceutical Industry. 5th Seminar of Economic Themes of Health; Paris, France; May 27, 2010.

Accountable Care Organizations in California: Lessons for the National Debate on Delivery System Reform. Integrated Healthcare Assocation; October 25, 2010.