This is the title of my Health Affairs Forefront article revealed immediately alongside co-authors Darius Lakdawalla, Jalpa Doshi, Louis Garrison, Anup Malani, Peter Neumann, Charles Phelps, Adrian Towse, and Richard Willke. The article begins by discussing among the professionals and cons of various approaches for CMS to set the utmost honest value (MFP).
Across these choices, we advocate utilizing a mixture of generalized risk-adjusted price effectiveness (GRACE) alongside equal worth of life years gained (evLYG).
Using GRACE plus evLYG combines the aforementioned three important elements CMS should take into account in a principled method to adjust to the statute’s non-discrimination precept. The solely rigidity between these strategies and the CMS memo (p. 50) is that the latter states that “CMS intends to use a qualitative approach to preserve flexibility in negotiation.” We advocate that qualitative evaluation be restricted to these issues that haven’t been quantified by way of prior research. Applying a pre-specified quantitative method to the remaining issues makes the worth negotiation course of extra clear and predictable for each affected person teams and producers.
More element describing the rationale for this method as effectively a 3-step methodology for implementation are described within the full article right here.