Treat Medicines Like Netflix Treats Shows • Hacker News Board

Re: Treat Medicines Like Netflix Treats Shows

#81

Post by alkibiades » Thu, Mar 07, 2019, 6:54 PM UTC

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

just curious, do you think it’s just a coincidence that US companies are responsible for the vast majority of medical innovation?

Re: Treat Medicines Like Netflix Treats Shows

#82

Post by Scoundreller » Thu, Mar 07, 2019, 6:55 PM UTC

Cool, I’d love to share my insurance with 3 people strategically distributed across time zones to avoid contention.

But please don’t send me emails about my insurance being suddenly used in Egypt. Those false alarms are really worrying.

Re: Treat Medicines Like Netflix Treats Shows

#83

Post by Alex3917 » Thu, Mar 07, 2019, 6:56 PM UTC

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

> The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy.

We should just have single payer that covers A) drugs not under patent B) drugs with breakthrough designation.

If people want other drugs that are patented they should then just have to get supplemental private insurance.

Re: Treat Medicines Like Netflix Treats Shows

#84

Post by _dw7s » Thu, Mar 07, 2019, 7:08 PM UTC

alkibiades wrote: post #81

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

just curious, do you think it’s just a coincidence that US companies are responsible for the vast majority of medical innovation?

Coincidence on what? What are you trying to say? Which facts correlate with that statement?

That the US has the largest influx of educated immigrants? That the US has the shittiest medical system? That the US has the largest health insurance administrative overhead in history? That free market capitalism applied to healthcare has birthed the opioid epidemic? All of the above?

Re: Treat Medicines Like Netflix Treats Shows

#85

Post by 3into10power5 » Thu, Mar 07, 2019, 7:11 PM UTC

I went to PAMF in Palo Alto, california yesterday for a "group diagnosis session" with the dermatologist. It seems dermatologist appointments are hard to get, so they came up with this method. You sit in a circle with other patients and doctor comes to each of you and quickly checks what happened to you and prescribes medicines. If she thinks it requires deeper consultation, she will scheduler private visits.

I thought this is a good system, especially if you are young and kind of know that what you have is one off fever or some such thing.

What am I missing? Why are more hospitals not following this? Why is no one applying to YC with this idea?

Re: Treat Medicines Like Netflix Treats Shows

#86

Post by vonmoltke » Thu, Mar 07, 2019, 7:11 PM UTC

lostapathy wrote: post #79

vonmoltke wrote: post #65

Earlier quoted context omitted.

> insurance software suggests cheaper generics to the pharmacist I have never heard of pharmacists using "insurance software". The pharmacy system requests coverage from the patient's insurance, and it is either accepted or rejected. Additionally, if there is a generic they just fill it, assuming the patient consents. In fact, pharmacists in many states are required to point out generic alternatives if they exist. >…

>If a prescription requires modification, the patient is required to go back to their doctor. Pharmacists cannot just ask doctors for prescription modifications. >Where are you getting these ideas from? This is not strictly true, at least in the US. I have had to wait while pharmacists contact the doctor to modify a prescription to sub something in due to availability issues. The mail order service through my insurer…

You're right, my statement was too absolute. What I meant to convey is that pharmacists cannot just ask for modifications without the knowledge and consent of the patient.

Re: Treat Medicines Like Netflix Treats Shows

#87

Post by munk-a » Thu, Mar 07, 2019, 7:13 PM UTC

patmcc wrote: post #59

will_brown wrote: post #46

Earlier quoted context omitted.

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

While I agree insurance companies do harm, encouraging generics is probably a net benefit. Doctors, just like anyone else, respond to marketing, so they remember 'viagra' more easily than 'sildenafil' and write prescriptions accordingly. There's often no medical reason a generic isn't 100% suitable.

This surprised me a bit but generics are not always a de-branded version of a medication or the same formulation manufactured by a different company. Often times generic equivalents are different formulations (sometimes prior generation formulas and sometimes divergent formulas) that are considered to have the same effect.

They nearly always do, but the weirdness of our stupid patent system means that sometimes they can have weird allergenic effects or (especially with neurological medicines that are less well understood) differing efficacy.

Re: Treat Medicines Like Netflix Treats Shows

#88

Post by fastball » Thu, Mar 07, 2019, 7:14 PM UTC

refurb wrote: post #78

fastball wrote: post #62

Earlier quoted context omitted.

Except drugs are different from other products. If a drug is actually a good idea for patients, with no profit motive behind it, it will sell itself. Doctors should be aware of the drugs the big drug manufacturers are producing, and prescribe accordingly based on need. If you need to hawk your drug by plastering TV ads all over the place, or by having salespeople push it to hospitals / etc., it's arguably not a neces…

If a drug is actually a good idea for patients, with no profit motive behind it, it will sell itself. This is entirely untrue. The one thing I learned in the biotech space is that doctors range from those doing research and know all about the cutting edge drugs all the way to doctors who are surprised to learn about a new drug that was approved a year ago. And there are way more of the 2nd kind. Changes to how condit…

Then that's a problem with your doctor.

Re: Treat Medicines Like Netflix Treats Shows

#89

Post by fastball » Thu, Mar 07, 2019, 7:14 PM UTC

creaghpatr wrote: post #70

fastball wrote: post #62

Earlier quoted context omitted.

Except drugs are different from other products. If a drug is actually a good idea for patients, with no profit motive behind it, it will sell itself. Doctors should be aware of the drugs the big drug manufacturers are producing, and prescribe accordingly based on need. If you need to hawk your drug by plastering TV ads all over the place, or by having salespeople push it to hospitals / etc., it's arguably not a neces…

Doctors don't just become magically aware of new drugs, it's not like every MD gets a newsletter a la "here's what shows are coming to Netflix". Treatments compete over the condition/disease just like any competitive market, even if a drug has a patent.

Why don't doctors just get a newsletter?

Re: Treat Medicines Like Netflix Treats Shows

#90

Post by will_brown » Thu, Mar 07, 2019, 7:19 PM UTC

vonmoltke wrote: post #80

will_brown wrote: post #75

Earlier quoted context omitted.

From the Center for Medicare and Medicaid Services. But like I said nearly no one knows any of this. Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. Again you can ask nearly any pharmacist and they have an outcomesMTM portal that feeds them automated recommendations on behalf of the insurance carrier. Some o…

> From the Center for Medicare and Medicaid Services. Please direct me to citations, not "try asking any X". > Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. MTM has nothing to do with insurance. > Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. outcomesMTM is not insurance software, it's pharmacy patient management software. > Here is another tidbit for…

You are asking me to cite things but what are you citing? You are simply saying “that’s not true”.

>MTM has nothing to do with insurance.

It’s required by law To be provided by insurers/health plans. If you refuse to talk to pharmacists or doctors about it, fine, you can read the law 42 CFR 423.153. In short insurance companies, must provide MTM services to patient covered in their plans.

It is also the single biggest metric in determining an insurers star rating. How could it possibly be unrelated to insurance if insurance companies have to, by law, provide it and it effects their reimbursement/star ratings?

>outcomesMTM is not insurance software, it's pharmacy patient management software.

That’s funny...the software certainly does manage pharmacists...on behalf of the insurance companies.

Right from the outcomes homepage:

“Contracted with more than 50 U.S. health plans, OutcomesMTM provides MTM coverage to 5.5 million patients. The company links more than 100,000 local chain, independent and health-system pharmacy providers with contracted plans across the country.”

Why does outcomesmtm contract with 50 insurance companies? Why does outcomesMTM “link” pharmacies with contracted plans?

“Targeted MTM services are designed to help plan sponsors improve performance for key Star measures, including the triple-weighted adherence measures. Prompted by TIPs in the Connect™ Platform, pharmacists work with patients to impact adherence and optimize medication regimens.”

As to generic substitutions...there are laws from state to state that allow pharmacists to do it, UNLESS the doctor says the name brand must be dispensed. I’m afraid that’s common practice, so permission is required. Plus when it comes to Medicare patients a pharmacist isn’t going to just change the RX to generic because they know they: 1 get paid by the insurer through these MTM portals to make the recommendation and 2 get paid again through the portal if/when the doctor agrees to the change.