Is this PBM tactic blocking healthcare access?

Utilization Management (UM) was originally a strategy designed to improve the safety, quality, and cost-effectiveness of physician prescribing. However, UM has grown exponentially over the last decade, becoming more a tactic for Pharmacy Benefit Managers (PBMs) to manage costs to benefit their bottom line.

The Realities Behind US Healthcare Spending

Healthcare policy is an all-encompassing term. It plays a role in every individual’s life; how it is curated, developed, and maintained has a significant long-term impact on the quality of life of any given community. It is critical that policymakers consistently adapt and amend healthcare policies in the ever-changing global pricing and affordability environment while providing funding support for optimal quality of care.

Cures for Patients, Not Health Plan Profits, Make Drugs Valuable

To the astonishment of many observers, the Institute for Clinical and Economic Review (ICER) recently concluded that a $2.1 million gene therapy for a life-threatening blood disorder called beta thalassemia, is priced cost-effectively. The surprise was especially pleasant, given that ICER’s methodology had, in the past, displayed bias against rare disease treatments and undervalued the lives of people living with disabilities.

Healthcare dominates the job market.

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Healthcare and social assistance are among the most important…

Caution towards CMS Data Sources for Healthcare Legislation

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Policymakers rely on accurate and timely data when implementing legislation or regulation to address biopharmaceutical spending in the U.S. Based on this research, policymakers may want to utilize other sources in addition to NHE data provided by CMS when making policy recommendations. 
This file is licensed under the Creative Commons Attribution 2.0 Generic license.

Healthcare Employs More on Cape Cod Than Any Other Sector

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Despite being a major tourist destination, the largest employment sector on Cape Cod is not related to tourism: it is healthcare!

Exploiting Charity Drugs: Hospital Program Earns Billions But Forgets Mission

Hubwonk host Joe Selvaggi talks with Pioneer Institute’s Dr. Bill Smith about his recently released paper entitled, "340B Drug Discounts, An Increasingly Dysfunctional Federal Program," which analyzes the evolution of a well-intentioned program to offer discounted drugs to the uninsured from a benefit that had helped charitable hospitals to one that has exploded to generate billions in profits while serving fewer uninsured.

How did COVID impact Massachusetts’ long-term care facilities?

Pioneer Institute has filed a Public Records Act request related to COVID's impact on Massachusetts’ long-term care facilities because the Institute believes this is a matter of obvious importance, both on principle (the public has a right to know the facts), and for purposes of evaluating – and where possible improving – public policy. 

The Promise and Challenges of Rare Cancer Treatments

Dr. William Smith, Pioneer Institute's Visiting Fellow in Life Sciences, spoke about the challenges and opportunities for rare cancer treatments, in a video interview produced by Rare Cancers, a patient group based in Australia, for the November 26th CAN Forum. 

A Closer Look at the Healthcare and Social Assistance Industry in Massachusetts

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From 2001 to 2019, far more employees worked in healthcare and…

Valuing Life-Saving Drugs: What is the Price of Life and Who Decides?

Hubwonk host Joe Selvaggi talks with Pioneer Institute visiting fellow Dr. Bill Smith about Quality Adjusted Life Years (QALY) standards, and the ways in which so-called objective cost-containing strategies use expert opinion to determine the value of a life and thereby disadvantage the elderly, disabled, and those with less common vulnerabilities to disease.

Massachusetts Should Disclose More Information about Its Recent Reduction in the Official Count of Long-term Care Deaths

The public -- particularly in Massachusetts, where COVID-19’s toll on elders has been so great -- has a right to know how many deaths occurred in state-regulated eldercare facilities, and how that compares to the total number of deaths. But the state's new counting standard clouds this information, and should be corrected or at least disclosed.

Doctor Heal Thyself: Insider’s Prescription For Healthcare Reform

Host Joe Selvaggi talks with surgeon and New York Times bestselling author Dr. Marty Makary about the healthcare reform themes in The Price We Pay, the 2020 Business Book of the Year.  The discussion covers the value of price transparency, provider accountability, and performance information to drive better medical outcomes and improve doctor and patient satisfaction.

Pioneer Institute’s 2021 Government Transparency Resolutions: Sunshine Week Edition

As it does each year, Pioneer shares the resolutions it hopes state leaders will adopt to bring government actions into better focus and invigorate our democracy with heightened public engagement. As the late Supreme Court Justice Louis Brandeis noted, “sunlight is said to be the best of disinfectants; electric light the most efficient policeman.”

Hockey Sidelined Again

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After months on the sidelines, youth hockey players across the state eagerly laced up their skates in August. Under current youth and amateur sports guidelines, locker rooms operate at 50 percent capacity, only one spectator should attend per player, and players wear masks on the bench. Unlike in MIAA high school sports, players do not wear facemasks while they play, except during faceoffs. 

Getting Nursing Home Care Right

Pioneer Institute has long recognized that seniors deserve the best of care and that innovative policy solutions are necessary to ensure that this population enjoys a high quality of life in their later years. In the 1990s, early 2000s and most recently in 2017, the Institute dedicated Better Government Competition topics to policy issues related to aging in America. Our goal each time was to find solutions and to take advantage of new innovations that would improve the quality of life and care for the elderly.

HHS COVID Funding Tracker

As of July, the Feds have distributed $86.7 billion to medical providers, of which $2.3 billion came to Massachusetts. Pioneer’s new HHS COVID-19 Funding app shows who and how much, from the $1 sent to American Current Care of Massachusetts, to the $418,034,675 sent to the MA Department of Public Health. We also break down the distribution by city or town.

COVID-19 Roundup from Pioneer: Why the divergent fatality rates?, Time for Telehealth, Missing the Greatest Generation, Senator profiting from COVID-19 & more!

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Pioneer staff share their top picks for COVID-19 stories highlighting…

COVID-19 Roundup from Pioneer: Tracking COVID-19 in MA, unemployment tsunami, cancel MCAS?, cell phone hygiene, salute to James Taylor, state tax filing & more!

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Pioneer staff share their top picks for COVID-19 stories highlighting useful resources, best practices, and questions we should be asking our public and private sector leaders.

COVID-19 Roundup from Pioneer: COVID-19 treatments on the way?, a COVID-19 Manhattan Project, best practices at Best Buy, “Expert Mercy,” a shout-out to a local high school, & more!

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Pioneer Institute's Top Picks for COVID-19 news, resources, best practices & more!

2019 Hewitt Health Care Lecture: U.S. HHS Secretary Alex Azar’s Remarks on Healthcare Price Transparency, Opioid Crisis, HIV Epidemic & More

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This past Monday, Pioneer held the 13th annual Hewitt Healthcare…

A Wealth of Data: A Map of the Massachusetts Opioid Epidemic

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In 2016, the rate of opioid overdose deaths in Massachusetts…

Can State Pensioners Pay for Future Medically Necessary Long-term Care?

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At some point many people find themselves needing help to care…

Bill H.2890: Funding More Problems than Solutions

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Studies show that 90 percent of the elderly want to live out…

Moving the Needle on Healthcare Cost Containment & Reform

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Today, Pioneer Institute submitted recommendations to the Commonwealth…

Creating Space for Healthcare Innovators in the Marketplace

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Pioneer Institute's initiatives in healthcare focus on three…

Time for Boston to open up to limited service clinics

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As a little girl I have a dim memory of my mother taking me to…

2017 Hewitt Healthcare Lecture: “Evolving Healthcare Delivery Models”

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Paul F. Levy, former President & CEO, Beth Israel Deaconess…

Improving Access To Health Systems Available To Older Patients

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Guest post by Alex Carlin As more Americans age in place,…