Technology Trends and Patient Benefits: Health Technology Assessments with Dr. Jason Spangler

Improving patient outcomes requires a close look at the latest innovations in healthcare. In this episode of Value-Based Care Insights, we sit down with Dr. Jason Spangler, CEO of the Innovation and Value Initiative, a non-profit organization focused on advancing the science of determining the merit of various clinical innovations. Dr. Spangler sheds light on health technology assessments (HTAs), their history, and how they help leaders decide which new technologies or devices provide interventional benefits to patients that includes clinical outcomes and cost analysis. Listen to gain insights into how HTAs consider clinical outcomes, the incorporation of health equity, and how social determinants provide a broader understanding of the benefits that shape healthcare decisions. 

• A health technology assessment (HTA) is a comprehensive analysis that evaluates the cost-effectiveness and clinical and societal impact of new healthcare technologies and innovations.  
• HTAs have to take into consideration many different kinds of value, from traditional quantitative clinical outcomes to more nuanced preventative measures and patients’ personal values.
• Technology plays a significant role in shaping the efficiency and cost dynamics of population health, with various assessments offering healthcare leaders deeper insights into where the benefits lie.  

LISTEN TO THE EPISODE:

 

Transcript:

Daniel J. Marino: 

Welcome to value-based care insights. I'm your host, Daniel Marino. When we think about population health. There's many interventions that are required to support the outcomes of our patients, of our populations that we're responsible for. Then it really does come down to people process and technology. And how well, not only those 3 areas are integrated, but how we leverage each of those 3 areas to produce the right level of outcomes. And it's difficult to evaluate really the return on any investment. Say, if you're investing in in the right level of staff, whether it's going to be our ends or medical assistance to run some level of intervention or the process. And certainly the technology. And with regards to technology because it plays such an important role. I'm creating the level of efficiencies that we need in order to drive the outcomes as well as then, the cost structure in population health. There's different types of technology assessments that have emerged to help give leaders the insights that are important to really identify where that benefit comes in and in particular. And this happens certainly more globally than I think in the United States. But there are health technology assessments, HTA’s, that have emerged to help leaders begin to really evaluate what that full impact is on the technology to people process and the technology, if you will. 

Well, I'm excited today to have a colleague of ours, Doctor Jason Spangler join us today to kind of dive into it a little bit. Dr. Spangler is CEO of an organization called the Innovation and Value Initiative IVI. Excited to talk about this today. Jason, welcome to the program. 

Jason Spangler:

Thank you, Dan. It's great to be here

Daniel J. Marino:

Before we dive into what hotel technology assessments are, and how, and their impact on population health. Why don't you spend a couple of minutes talking about? IVI sounds like a really interesting organization.

Jason Spangler:

Thanks, Dan. Thanks. Again, thanks for the opportunity. Yeah. The Innovation and Value Initiative is a nonprofit research organization, that focuses on how do we do a better job advancing the science and improving the methods of how we determine the value of new innovations or technologies in the healthcare space. And so when most people think of new innovations and technologies, we're talking about new medicines, new devices, new diagnostic tools, etc. And what we want to do is not only improve how we determine how valuable they are to patients and to society as a whole, but also to see how they're better utilized so that we can make better decisions to improve health outcomes for patients and populations. 

Daniel J. Marino:

Does it support leaders here in the US. But are you a global company, or is it most of the work done in the US?.

Jason Spangler:

Most of the work has historically been done in the Us. Though recently we've expanded beyond the Us. And particularly within other developed countries that also use health technology assessment or HTAs like those in Europe, Canada, Australia. But we're just starting to have more of a global presence. Historically, again, it's mostly been in the Us. Our work has been done.

Daniel J. Marino:

Yeah, it's interesting. I read a few of your of your press releases and white papers and sounds like you all are doing some interesting things, some I'm excited about diving into it. Why don't we talk a little bit about what health technology assessments are, or HTA? Talk a little bit in terms of maybe give some of oversight or some objectives of what's the HTA is?

Jason Spangler:

Yeah. So you know, HTA’s are about 50 or so years old. They were mainly developed in Europe initially, and the idea behind them was that the Government was paying for new innovations in their healthcare system, since most of the healthcare systems are government funded and or government run. And they want to determine you know, how much should we actually pay for these new medicines or these new devices. And so what they did was basically a cost effectiveness, analysis and a budget impact. So I'll you know, just easily explain those 2. So one is, you know, the cost that we're paying. What are the benefits we're getting? So you know, it's a denominator enumerator, denominator. So the numerator is health outcomes. What are the, you know? Improvements in health? And then the denominator is cost? How much is it costing us? And then what's the overall budget to our healthcare system for these new innovations that we're paying for? So it's basically trying to determine, you know. Is it worth it to incorporate and pay for these new technologies that are being developed to help improve patients? Health.

Daniel J. Marino:

Yeah, well, and when you think about evaluating the but the financial benefits, or return, if you will. The cost, which typically is the dominator, it's easy to figure out. But the numerator in terms of what you're trying to savor. The impact on that is, of course, a little is a little tough, right? I kind of think about care management. Right? Because if you do care management well, you're preventing some future diseases or occurrences that are occurring in patients. So how do you create that return around something that that you're reducing, or that level of impact. So when you think about that, how do? How does the HTA then, talk a little bit about some of the components. How does that figure into some of the decision making that population health leaders might consider? 

Jason Spangler:

Yeah, that's a that's a great question. And the your question is a question that health economists have been asking since basically, the creation of HTA’s. For the most part, what they, the outcomes they look at and the easier ones to look at, or the actual, the clinical outcomes. Right? And so, if you're talking about cancer? Right? Does it curing cancer? Or is it, you know, extending life, those sorts of things that are easier to measure. What are more difficult to measure, you mentioned, one is something that's preventing future, you know, bad outcomes, and that's a little bit harder. 

The other aspect, I would say. And what we focus a lot on is things that patients value, that aren't, that go beyond just typical health outcomes, you know, if they, if they want to live a certain amount of time, because, you know, they want to make it to do the wedding of their child or the graduation of their grandchild, or something like that. It's hard to measure that. And there's other aspects of value that are important, too, because you know certain medicines, for example, they might not be developed for their original purpose, but the science behind it actually leads to the development of another medicine that actually has a greater benefit. And so that original medicine had some value because it helped for a future medicine. And so and but it's harder to measure those things. And that's some of the work that we're trying to do. How do you do a better job of measuring those aspects of value that patients prefer, and incorporating them into kind of the technical or mathematical work that. An HTA historically does. 

Daniel J. Marino:

Yeah, just on on the surface, you know. Certainly I you could see a lot of value right? Because if you're if you're thinking about evaluating like you said one medicine against another and tracking against sales outcomes there, there's a cost, and there's a there's a value to that. I think, with devices that would probably be. That would probably be the case. Are, are you? Is is IVI or with the HTA. Is it looking at, say active health, equity, or any type of outcomes to the patient relating to? I don't know some of their lifestyle issues? How is that piece of it incorporated into the HTA?

Jason Spangler:

Yeah. So again, historically, it has not been. That is one thing that we are very passionate about. And we've been doing a lot of work and trying to get aspects of health, equity, social determinants of health. Again. These are all part of, you know, the patient centric approach. Obviously, equity is very patient Centric is important to patients, particularly those and undeserved populations. And so again, it hasn't been done. And so we, one of the things that we have been working on with partners is trying to see how you can incorporate those aspects of equity into the process. Because there are like you mentioned, there's aspects of value that are important to patients. And particularly certain patient populations may emphasize aspects that others don't or may be important. Or there might be social determinants of health that affect minority populations more than others. And so how do you think about those when you're calculating the value of a new medicine.  

And let me let me just give me an example. So transportation is a good example. If you're looking at 2 different devices or 2 different medicines, and then one is something that will take a medicine. Say one is something that it's in a pill form, that the administration is easy, because you can just take it at home versus say it's in a, you know, intravenous or infusion, where you have to go to a healthcare facility to do it. You know, a social determine around that is transportation. Right? Transportation can be difficult for certain populations. And so how do you add that aspect into calculating the value of the one medicine versus the other. And so it, you know, form of administration is not something that historically, an HTA has looked at but that is something that's really important to certain populations, and it would make one more valuable than the other. And so one of the things we try to do when we're developing models and trying to improve methods is to incorporate aspects like transportation into the value calculation. 

Daniel J. Marino:

Oh, that's great. I'm really a that's a great example. And you know, as you know, CMS, now really beginning in in 2025, and with further reimbursement, they are looking at health equity measures. That's going to be an important part of the way that they're going to be holding providers responsible and obviously creating some level of incentive. So to incorporate that into the to the value equation. If you will, I think, is really going to be key. 

If you're just turning in. I'm Daniel Marino, and you're listening to value based care insights. I am here with Dr. Jason Spangler, CEO, of the innovation and Value initiative, and we're talking about health technology assessments. 

So Jason, just want to build off that for a second. So when you think about, then that aspect of transportation and you think about, then the medications and so forth. Where health leaders, how do they get the information? What does the model look like? 

Jason Spangler:

So I can give you several examples of that. A, as you mentioned in the beginning about the global versus US. Aspect, because the US. Healthcare system is such a mix of private and public payers and insurers. We don't really have Hta. Here we have. There isn't a private organization that's a nonprofit. That kind of does some of these assessments. And we might get to this later. CMS is kind of looking at this, you know, regarding the inflation reduction act. But each insurer or private payer kind of does their own assessment already. And so if they want to get more information, they can go to like a nonprofit that's doing this. Some actually look at HTAs in other countries, whether it's Canada or the Uk, where they think there may be similar populations that may affect. You know, their beneficiaries. Obviously, they can come to our work. We don't. We don't do actual assessments, but we build the models that you can do your own assessments. And so, you know, we love to talk to folks and partner on that. 

You know, one of the issues, Dan, is data. How do you get the inputs for even like our model, you know, where is the data for stuff like transportation? Right? And most of that is qualitative data from you. But you basically have to survey your beneficiaries. There are some partnerships between private payers and transportation companies like an Uber or a lyft. And so they're trying to get some data there. And, as you mentioned, you know previously about, you know how important it is for healthcare leaders and healthcare systems. Some are actually starting in the private sector you mentioned CMS. But even in the private sector some are actually starting to pay for transportation as part of the benefit patients, because they realize the importance of social determinants and equity. And we're just starting to see that. And that's one of the things we're pushing more for. But there, there aren't a lot in the Us. A lot of resources for this. I think you know, our organization is obviously one there's a couple of others that are doing this work. There's academic institutions who are looking into this as well. But again, this is a newer thing in the Us. And it's only been probably getting more prominence in the last 10 to 15 years. But you know, if we and we can touch on this, as you mentioned, CMS is starting to look into this, and is the more they look into this. I think more of the healthcare leaders in across the country will look into this. 

Daniel J. Marino:

Well, it it's, it seems to me it brings forth a a broader perspective of evaluating. The intervention, right? So you're not only just incorporating the technology but then other aspects of those things that really impact patients. And in particular, I'd like your transportation example. I have a client right now who manages a Medicaid population and they have a pretty strong care management program, and they've also have built a relationship with a local transportation company. So when you, when you look at the cost of the transportation. And then you look at the cost of the nurses that are performing the intervention, and then the technology overlay. It's very expensive. As a matter of fact, you know clearly they're losing money, I think when we did the calculation on it on a PMPM. Level, it was somewhere around $15, $16 $17 per member per month. They were getting a small compensation care management incentive from the plan, I think, was like $3 and 50 cents. So clearly this was, this was an investment. But as I was going back and talking to the population health leader, his big question to me was, where does the return come in? So having you talk through this HTA, it makes sense that this level of a broader perspective really would come into play to help us understand what the outcomes are, what the cost is and then how they should be able to add.

Jason Spangler:

yeah, yeah, definitely. And can I?  You sparked something in my mind when you just mentioned this, because we are very focused on the patient, right individual patients. But there is also a an aspect of kind of societal benefit as well that you and this goes along with what you mentioned earlier around population health. And, you know, trying to incorporate both of those, because there's a lot of new technologies that you can focus on the value to the patient and can address some of those. At the same time it has a larger societal benefit as well, and I think we don't want to lose sight of that and the trick is kind of so to speak, is to make sure that you're incorporating both of those right? You just can't focus on population as a whole, though, that's really important because individual patients get lost. But you can't just focus on individual patients, because we know that you know, all of these things are integrated, so to speak, around the whole healthcare system. And our, you know our job when we're trying to develop better methods and advancing the sciences to try to do both. 

Daniel J. Marino:

Yeah. And that's a good point. It has to be balancing. Act right? You have to meet the patients where they where they are in order to deliver the care that they need. But we have to also focus on the populations that we're managing and that, and that we're responsible for. Can you walk us through an example? Spend a couple of minutes just talking through? The HTA under an example? Whether it's more of an acute situation that you were managing through a patient or man, maybe even managing through a population. Can you walk us through a model? 

Jason Spangler:

Yeah, sure. Let me. II can do kind of 2 brief examples. Let me focus one on a model that we just launched around major depressive disorder.  

Daniel J. Marino:

Oh, good. Yeah, that's a good one. 

Jason Spangler:

Yeah, As you know, behavioral health has become more and more important over the last few years. The pandemic just kind of added to the importance of that and people realizing. And so we built this model really focusing on not just kind of direct drugs, and how they affect. But one of the great things we were able to do is to look at. you know, non pharmacologic interventions or therapies, as well as pharmacologic and compare them to each other. But in addition to that, we're able to build in these other aspects of patient, focused value that that we talked about. One was transportation costs. If you're taking a you know, an antidepressant at home, that's very different than getting psychotherapy where you have to go back and forth right to a therapist. And then the other aspect you mentioned, you know what's the return. The other aspect that we incorporate into this model was around productivity. So we divided that up between absenteeism and presenteeism, you know absenteeism people not being able to go to work because of the condition.

Daniel J. Marino:

That’s the productivity of the of your patient? Not necessarily productivity of the person who's doing the intervention or the therapist?

Jason Spangler:

Yeah of the patient itself. And so, yeah, exactly and so, and then present to them is those who go to work. But aren't, you know, performing the way they should? And so we were able to use data from kind of productivity data. We added some transportation costs or some other kind of non direct healthcare costs, but we were able to incorporate all of that into the model, so that you can compare a whole bunch of lines of therapy right? And so you know, combination therapy, you know, psychotherapy itself and the drugs. And so that's an idea of, you know, or an example of a model where you're trying to build in the simple kind of data, the cost around the drug itself, or you know what the psychotherapy as well as these other aspects of value. And then kind of compare. You know what are the total costs, what are the costs per outcomes? And then you can kind of see the overall clinical cost, effectiveness, and compare, you know, different types of drugs as well as drugs with, you know, psychotherapy. So that's really exciting.  

Let me just briefly mention, you know, another. You know, we work in the rare disease area as well. Simple cells. Another example, where people have looked at a lot of new therapies, particularly gene therapies. But one of the things we have seen, particularly from an equity. Perspective is assessments to date have not looked at some, you know, what we call kind of patient, focused or patient. Even the term patient, important outcomes in the sickle cell community. So one of those is ones that we mentioned previously. Right transportation costs. There's many different types of treatments for sickle cell. And now new treatments with gene therapy. And transportation will change, depending on that. Another aspect that is not calculated in this population which definitely has an equity lens to it is around pain events that happen outside the hospital. So a lot of sickle cell patients have pain events, and they don't. They know how to deal with them at home, and so they're not measured at the hospital, but a therapy that lowers the number of pain events treated outside the hospital is obviously going to be more valuable to that patient community than those that don't. But that isn't typically calculated into an assessment. And so that's an example, again, of how to get not only a patient, focused or patient, important preference or outcome that they want. But also it brings in again kind of an equity perspective. You know that you normally wouldn't think about for a different type of therapy for a specific disease. 

Daniel J. Marino:

Oh, that's fascinating. And you know, II think the as you're as you're talking about it. I can see the real value of this, because the HTA certainly brings in a much broader, more comprehensive approach. I'm looking at the different aspects of interventions or medications, or what have you taken into consideration other things that impact the patient. And especially as you know, we mentioned a little bit about this, as CMS is starting to focus more on health equity lifestyle issues and social determinant issues. Those things have to come into play when you're really evaluating the output. I think the HTA. It sounds to me that really aligns well taken into consideration these other factors.

Jason Spangler:

Yeah, I would agree with that if I would say the big if there is. If CMS actually looks at it from the perspective of their beneficiaries and considers things that their beneficiaries are important, right? It's easy to kind of just look at the you know the cost to Medicare, of all the drugs that they pay for. And just look at that, and not really look at kind of what do their patients really value, and adding that equity component that we discussed as well. You're right, that, you know, health equity is one of the major pillars of CMS's strategic plan. But Medicare, when they're looking at and comparing different types of medicines and trying to determine how much they should be paying for them. They can't forget. You know what their patients, you know, their beneficiaries prefer, what are the outcomes they really want, and then they need to consider those equity components as well, or you're going to have populations that are, you know, they might need the medications at a certain price, and they might not get access to the ones that benefit them the most. If CMS doesn't consider those right? 

Daniel J. Marino:

Right. So if we have a lot of folks who lead clinically integrated networks or ACOs, or obviously our leaders of population health within their organizations. Any thoughts on where you can direct our listeners if they're interested in and learning more about HTA, or maybe some aspects of the model, or even some output of how these assessments have actually benefited organizations similar to those that they're that our listeners work at.

Jason Spangler:

Yeah, sure. So first, I would say, you know, come to our website, the value initiative.org. We have all of our models that people can look at. We have additional work and papers information research. We've done over the years to. you know, to help educate the people that you're talking about. I would also add, we have an annual method summit that talks about kind of the methods we use in advancing the science that's coming up in on March fourteenth information’s on our website. Yeah, I'd love to people. It's in person. But we're going to live stream it. So we'd love to have people look into that, I would say, to look for more information around HTA itself, you know, professional societies, you know, there's an organization called Ispor, which is basically the International Society of Health Economists. They have a lot of good information on what HTA is, how it's used in the Us. And outside the Us. I would highly recommend that. You know, our listeners follow what CMS is doing around drug price negotiation and the inflation reduction act, because, as we mentioned earlier, you know, people follow what CMS or what Medicare does in the private sector. And so I think it would be, it'd be wise to kind of follow what they're doing.  

And then the last thing is, as we mentioned, you know, other countries have done this for years. I wouldn't necessarily model what they've done here, just because their healthcare systems are different than ours. But there are certain ideas, and they have much more experience about. You know how to incorporate the things that we've talked about, and they're always trying to do a better job of, you know, looking at what the patients are doing. So, I think there are many different opportunities to kind of get more educated. And I think this field is going to continue to grow in the Us. Because obviously, want to be, you know, provide the highest value. Care. Be as efficient as possible, not waste health care dollars, and try to improve the population of patients. You know, as a whole. 

Daniel J. Marino:

Well, and it's complicated, right? There's a lot of factors that come in. If you're truly going to manage the patient correctly. That you know, and those factors, they go beyond just what happens in the clinic setting all of the social, determinant factors, all of the lifestyle issues, those definitely come into play.  Well, Jason, this is fantastic, great discussion. I really appreciate you taking time to join our program today. If any of our listeners want touch base with you directly. Do you share your email? Or are you linked on Linkedin? 

Jason Spangler:

I am on Linkedin. My email is just jason.spangler@thevalueinitiative.org Feel free to reach out to me. And, Dan, just thank you for this opportunity. It was great to speak with you today. 

Daniel J. Marino:

Great, well, thanks again, Jason, and maybe you can come back some time and dive into it a little bit in more detail, maybe after your conference. So thanks again for joining. And I, in particular, want to thank everyone here for listening today. Thank you for your time, and until our next insight. I am Daniel More, bringing you 30 min of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners