December 4, 2023

That is the title of my Health Affairs Forefront article published today 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 execs and cons of various approaches for CMS to set the utmost truthful value (MFP).

Throughout these choices, we suggest utilizing a mix of generalized risk-adjusted price effectiveness (GRACE) alongside equal worth of life years gained (evLYG).

Utilizing GRACE plus evLYG combines the aforementioned three crucial components CMS should take into account in a principled method to adjust to the statute’s non-discrimination precept. The one stress between these strategies and the CMS memo (p. 50) is that the latter states that “CMS intends to make use of a qualitative method to protect flexibility in negotiation.” We suggest that qualitative evaluation be restricted to these concerns that haven’t been quantified by prior research. Making use of a pre-specified quantitative method to the remaining concerns makes the worth negotiation course of extra clear and predictable for each affected person teams and producers.

Extra element describing the rationale for this method as properly a 3-step methodology for implementation are described within the full article here.