New Ways to Fund Healthcare

Dr. Andrea Feigl  0:03  
So we're constantly coming up with these results that we're losing 5% of GDP, both in high income and low income countries, because we're not investing in things that we know that work, which is adherence, access and prevention for chronic diseases.

Terry Wilcox  0:18  
 Dr. Andrea Feigl is the CEO and founder of the Health Finance Institute. They focus on finding financing solutions for chronic diseases. On today's episode, we break down some of the complexities behind where finance and health intersect and why it matters for your ability to access care. Welcome to the patients rising podcast. I'm your host Terry Wilcox, CEO of patients rising, I'm joined by my co host. And speaking of finances, he can't wait to see the Yankees finance a deal for Shohei Otani.

Bob Goldberg  0:53  
He's five Goldberg, co founder of the Center for medicine in the public interest. Terry, look, as everybody in the audience knows, you know, Otani is wasting away on a middling team. He should come to the Yankees. And I was hoping that Andrea would talk about how to finance get some public private financing to bring him over to the Yankees this year. But it isn't a sports podcast, Terry has you know, even though I'd love it to be, we're talking about healthcare, as we always do, particularly the latest health care policy news and trends from Washington, and tried to explain how it impacts millions of patients in the chronic disease community. So we have patient stories, experts, insights and news all delivered in one place on your podcast app. And how can you beat that? Well, you can't Bob. And we do have a terrific guest today. And I can't wait to hear from her. But I actually wanted to begin today's episode by discussing a brand new survey from acid patients rising. That's all about patients and their ability to access Naloxone at the pharmacy. That's right. And then as the opioid crisis continues to devastate community after community, deaths of despair, as they're called, we really wanted to understand the experience people are going to when they're dealing with the comes to accessing opioid overdose reversal medications. So Terry, tell me a little bit about the survey and what it means for access. 

Terry Wilcox  2:28  
One of the reasons that we decided to do this survey is that the standing order, and for those of you aren't familiar with the standing order, basically, you if a medication has a standing order, you can walk into the pharmacy say you need the medication, and they hand it to you at standing order. But not everybody knows about the standing order and how they work. And even some places where you try to go, even though there is a standing order in that state, they still give you problems. And it doesn't always necessarily work. So the survey covers how to access Naloxone, currently, with a standing order. One of the other things that we talked about as nearly one in five or 18% of those that we surveyed, were not even aware that they could use a standing order, right? They're not even aware of it. One of the issues with those that know about a standing order is there's a stigma in going and asking for something for free. Or saying that you need Naloxone, right? There's always been a stigma surrounding Naloxone because of what it does. And for those of you who don't know what Naloxone does, it can stop an overdose, right in its tracks. But it doesn't always have to be drug abuse, overdose, it can be accidental. 

Bob Goldberg  3:42  
Yeah, I think this is where groups like patients rising, and doctors need to work together to de stigmatize this. We have a campaign here in New Jersey, Saved a loved one from Overdose, which basically says, Hey, if you don't want to ask for it, let's go with somebody else to get it for you. 

Terry Wilcox  4:04  
You need to de-stigmatize things like this and normalize them so that patients feel safe, and that they can access something. Without that without that extra burden. You know, all of these things as a patient are hard enough as it is. 

Bob Goldberg  4:20  
Yeah. Now, on to our featured guests for today, who has set out to help close what she calls a financing gap for chronic diseases. Dr. Andrea Feigl is the founder and CEO of the health Finance Institute, that builds public private finance and partnerships, to invest in disease screenings, to healthcare infrastructure, access to new medicines and research and development. She was an economist at Harvard, working on this issue with the UN and high level meetings. And she got tired of rehashing the same data. You know, the question was, what can we do to reframe the value of medicine using other datasets and data tools to attract greater investment. 

Dr. Andrea Feigl  5:10  
So we're constantly coming up with these results that were losing 5% of GDP, both in high income and low income countries, because we're not investing in things that we know that work, which is adherence, access, and prevention for chronic diseases. And so I saw like both a, an opportunity for an organization to basically make sure there's a translation of that evidence, but also to bring in more private sector finance, which is really lacking, but supposed to basically account for 20 to 40% of the health financing gap, analysis, the sustainable development goals. So there's two things and actually, there's a lot of overlap with what we talked about on the podcast. And for two reasons. First, non communicable meaning chronic diseases are the fastest growing source of disability and mortality in the developing world. And secondly, they just like we, in this country, seem to find it difficult to find the right value measured to drive the debate about increasing access. So the question is, setting aside, you know, the government, how do we encourage the private sector to invest in health care access, in terms of funding? What's out there? What can be out there? You know, we have to sort of reframe, and we've talked about this before, like, we place a high value on reducing carbon, but we don't use the same set of metrics, in valuing a cure from cancer. And that's something that, again, patients rising, has addressed in the most recent principles for, you know, access to care that was released by the affordability group, 

Terry Wilcox  6:52  
What Dr. Feigl said, initially, in her statement, just now, we're not investing in things that we know work. Yeah, adherence, access, and prevention for chronic diseases. And if you're going to create health plans that essentially create millions of Americans on underinsured plan, putting them on underinsured plans, where the out of pocket costs, keep them out of reach of obtaining adherence, access and prevention. 

Bob Goldberg  7:28  
You know, she raised a question and of course, I wrote in my in my article, again, we can look at the upfront cost of all these environmental regulations and the cost of electronic vehicles. And we can put $1 value and the societal savings, that includes reducing deaths and disease, but incredibly in the same bill, the same inflation Reduction Act, we, we devalue, we're going to systematically devalue drugs that provide long term benefit to patients, not just savings, but increased productivity, increased peace of mind, greater help, and we're taking the rebates from the price controls we're using to finance electric vehicles. It's insane. So just like those carbon credits, Andre explains that we could have a health impact credit. To do that, you need to understand you know, what the health footprint that accompany plans on society. So think of the carbon footprint and let's we can just take it from there. 

Dr. Andrea Feigl  7:28  
I sell this idea to my son and see if it flies, he's nine, he's very precocious, but necessary him, you know, like, think about rating companies, right? He's doing 100 and zero. And he says, Yeah, Moderna will get 95 and McDonald's will get 27. Right? And I say, Well, why do you say that? Was it? Well, moderna developed really great my rexine for COVID. But not everyone got the vaccine, and it doesn't cure it. Right. But McDonald's has some salad, but not enough, you know, so he gets it. Right. 

Terry Wilcox  8:58  
So how does this translate into a health credit? Like, how does this analogy from her son? Yeah, translate? 

Bob Goldberg  9:07  
Well, I'll give you a couple of examples. So PepsiCo, you know, over the last five years, has been systematically reducing the amount of sugar portions and so on, we are able to measure the impact that has on say, obesity or other diseases. But let's say you know, you still want so you can get paid for that. Ultimately, let's say a company that, for example, develops a anti opioid overdose product, saves lives, they should be able to take the lives that are saved, and convert that into a credit, which they can in turn trade to McDonald's or Pepsi Cola. So Pepsi Cola can continue to make Kentucky Fried Chicken and maybe extra crispy for people. So they can stay in their lane as you point out because not everybody's going To have the opportunity to make as much of a contribution, what you want to do is create a market for the long term benefits, which is something that the stock market does the futures market does. excetera another example, could be that, you know, a health plan, which worries about right now, we'll say, Well, you know, why should we invest in these new medicines since a year from now, these members are going to move to somebody else? Well, you can, again, a market, a futures market could allow you to sell those credits to another health plan and use that to underwrite to reduce your risk exposure. 

Terry Wilcox  10:39  
So I want to hear about what Dr. Feigl had to say on what this system would look like. 

Dr. Andrea Feigl  10:44  
The health credit that's being issued, can be traded, and then you know, it becomes you can tokenize that you can create a market as well for it. And then you know, McDonald's can buy credits from moderna, right, or, or Coca Cola can buy credits from Whole Foods or things like that, because what we eventually want to do is internalize both the negative and the positive externalities, because we know that each unit or health doesn't just relate to profits, but each of health also relates to the macro economic economy. And each unit of health also relates to, you know, economic well being and growth.

Bob Goldberg  11:25  
What about people with rare diseases? How can this help them? There, I think there's some great opportunity, maybe we can explore this in another show. But let's say you continue to take a single stock for a single company, or a portfolio of development projects, you as an individual consumer or investor, or a hospital can invest in this instrument based upon the future benefits that are going to be generated. And market assigns $1 value to almost everything, we had to sign the dollar value to hope in the markets all the time. That's what options are. That's what puts our we haven't been able to do it in large part because of the lack of granular data. But we now have massive amounts of data we have EHRs. So we're really at the tipping point for developing a market that will truly value from a patient's perspective, what you want from better health. So we're a little bit ahead of the curve, but I think we have a great opportunity. 

Terry Wilcox  12:29  
And these behind the scenes conversations that we have here on how we pay for health care, they're so important, because it all trickles down to you the patient. How we finance new medicines can determine how affordable and accessible they are, when they come to market, and what new treatments or even cures can be developed with this new funding. So if you want to learn more about how the Health Finance Institute is reshaping the way we pay for health care, which we are in desperate need of, you can head to the link in the show notes.

A few quick updates for you before we go. Last week, patients rising now hosted a great discussion on Capitol Hill about accelerated approval and our new report. We heard from patient advocates including last week's podcast guest mailman, and numerous policy experts about why access to accelerated approval drugs is so important for patients. Yeah, tell me a little bit about it. What was the takeaway? Well, the takeaways were at the end of the day, CMS needs to get their paws off the FDA. And that's not a quote from me. That's a quote from Sue Peschin. Look, we had a panel of experts including a patient the longest living Gleevec patient, which we had on last week. Gleevec was approved through accelerated approval. And one of the key takeaways and we cannot focus on this enough because so many people miscommunicate this accelerated approval is approval. 

Bob Goldberg  14:37  
Yeah, it's just faster approval using the same benchmarks and tools that the FDA use it for everything else. 

Terry Wilcox  14:44  
Exactly. That's the one thing and the second thing to that is the misrepresentation of the 13% of accelerated approval medications that are either delayed or delinquent on their confirmatory trials. Alka Bhatt told us in the room and we'll link to, we can actually link to the report in the show notes. But one of the new things that she really honed in on for us was, look, these companies aren't just not doing their trials. A lot of times there's trials are so successful, that they're not able to meet their endpoints. 

Bob Goldberg  15:21  
Right? The main reason that these trials are not fulfilled is because the drugs are working so damn well, who wants to go into a clinical trial after they've already had a treatment to see if the drug works that they know that works? So that's one thing. And the second thing is word of mouth and the community gets around us. And if you can get this medicine prescribed by your physician, why wait for a clinical trial to do it? Yeah.

Terry Wilcox  15:48  
So what else have we been tracking Bob? 

Bob Goldberg  15:50  
Well, I mean, in good news, you know, we talked about RSV, RSV respiratory syncytial virus, it's a very common infection viral infection. Until this year, there wasn't a vaccine for it. It was approved for adults a few months ago, and now it's going to be ready for use for infants this fall. That remains to be seen as the vaccine will be included in the vaccine for Children's Program, which is a program that allows people with low income to obtain vaccines for free. My guess is that they will. And you know, it's one more affliction that we as parents and grandparents can avoid thanks to innovation advisors to the CDC. 

Terry Wilcox  16:37  
We'll meet this week to decide if this shot will be included. We'll have a link to our past episode on RSV and more information on the latest developments in the show notes. Thank you for listening to today's episode of the patient's rising podcast. Don't forget to pass this episode along to a fellow advocate. And make sure to follow the podcast on your favorite podcast app. We'll be right back here on Monday with another new episode. Until then, for Bob and everyone a patient's rising. I'm Terry Wilcox, stay healthy.

Dr. Andrea Feigl  0:00  
And

Terry Wilcox  13:04  
This episode of the patients rising podcast is brought to you by the patient's rising helpline. This free service is just one of the many ways we try to help our patient community. Patients oftentimes have trouble finding medical transportation, or trying to understand their insurance. And that's where we jump in. We have navigated hundreds of individual situations with patients. If you or someone you know has a health care question, challenge or issue we are standing by and ready to help to get in touch, leave us a voicemail, or send us an email using the link in the show notes.