Speaker Spotlight: Dana Goldman, Ph.D., Director of the USC Leonard D. Schaeffer Center for Health Policy and Economics, UCLA Adjunct Professor

Goldman is a nationally-recognized health economist influential in both academic and policy circles. He is the author of more than 100 articles and book chapters, including articles in some of the most prestigious medical, economic, health policy, and statistics journals. He is a health policy advisor to the Congressional Budget Office, and is a frequent speaker on healthcare issues. He joins us July 12 at UCLA for “California: Uniting Science and Policy to Advance Cancer Care.” It’s not too late to register for the event – contact Marisa Reinoso at reinoso@chi.org.

Q: What policies have greatly impacted cancer care in your opinion?


A: I think what people don’t realize is just how important reimbursement and other health policies are in terms of changing the way treatment gets delivered. For example, if you look at the rules for Medicare reimbursement, most of the reimbursement has been generous, historically, for infused therapies. And the result is that we have many infused therapies for cancer. And the question is whether that generous reimbursement is going to continue. Even more important is the relationship between reimbursement and future innovation.

The idea is that we have the luxury in the United States because we have reimbursed, historically, at generous levels that, for our conditions, we’ve actually made progress. We’re actually winning the war on cancer and we’re doing it through treatment, as well as diagnosis. The issue is whether that type of progress will continue.

Q: You talk a lot about the importance, both from a health standpoint and an economic one, of prevention and preventive care. How much of this will rely on medical diagnostics and advanced technologies and how much is it reliant on an individual to change his or her behavior?

A: What we found is the change in behavior is notoriously difficult. If you roll the clock back 50 years and you think about hypertension, it has always been a serious health dilemma in this country. But we know there are behavioral modifications that will help people – they can change their diet, reduce their salt intake and exercise more. But what we found is that very few people comply.

Actually, the introduction of drugs, mainly beta blockers, diuretics, calcium channel blockers, and a whole host of therapies, have actually resulted in incredible improvements in cardiovascular-related mortality in the United States. These classes of drugs have been a huge success and they have been able to substitute where previously we had to rely on behavioral change. There is an important lesson here. Yes, we’d like to modify behavior. And, yes, behavior change has value. But it is also important that we continue to innovate to find ways where biomedicine can fill those gaps.

Q: How do you see California leading the way in terms of healthcare following the Affordable Care Act, with so many uninsured?

A: As in so many areas, California is one of those states that defines the way other states will react to policies. As you know, we face a severe fiscal and economic crisis in the state. It is easy to say one of the reasons for this is healthcare, so we should be working hard to reduce reimbursement in many areas. But it is important to realize that California is also the engine for biotechnology and biomedicine is one of the engines of growth in this state.

California has a reasonably competitive health insurance market. In the private sector, they have been initiating reforms that will drive reimbursement down where it needs to be driven down. And it will drive up where we need to reward value. We should be careful to make sure that we encourage those markets to work as efficiently as possible. And that may mean even raising reimbursement in some areas.

Q: What’s been consuming the majority of your time these days?

A: I have been spending my time trying to think about other ways that we can 1) reimburse high-value therapy and 2) come up with better models to try and understand the short- and long-implications of disease. For example, if you think about a country’s progress generally, and we tend to look at gross national product or gross domestic product, but we don’t take into account the health benefits that countries might get from various interventions. And that is an important part of progress. We need to find ways to promote not only longevity but also better quality of life when people get older.

There’s been a lot of focus on the ACA and its short-term implications. We are the only center that I know of that is actually thinking about how will this affect innovation in the long-term.

Q: What are you most looking forward to hearing about at “California: Uniting Science and Policy to Advance Cancer Care” on Thursday?

A: I’m looking forward to “The State of Cancer Research in the Golden State” and “Improving Access to Advanced Treatment” panels.

I think it is important we promote access to therapy and we do not end up with a world where we have large disparities in access because only the wealthy can get access to these therapies. At the same time, we have to make sure we can reimburse them appropriately.

Really, access to care is going to be a key issue going forward.




CHI-Advancing California biomedical research and innovation

California Healthcare Policy Forum Spotlight: Ian Morrison

In the run up to CHI’s annual California Healthcare Policy Forum, which this year, will take place on Nov. 5 at the Mark Hopkins InterContinental Hotel in San Francisco, I will be interviewing the various opinion leaders we will bring together to discuss California’s innovation economy, its place in the current healthcare debate, and how healthcare reform promises to change the provision of care in years to come. Ian Morrison, internationally known author, consultant, and futurist specializing in long-term forecasting and planning with particular emphasis on healthcare and the changing business environment, will be the moderator of the event and is the subject of my first interview. He combines research and consulting skills with an incisive Scottish wit to help public and private organizations plan their longer-term future and promises to deliver an impactful, interactive session among industry leaders, policy makers and academicians on the future of healthcare in America.

Registrations are still available for the event. Click here for more information.

Q: What will be the focus of this year’s California Healthcare Policy Forum?
A: It’s going to be a very interesting meeting. The focus is going to be on helping attendees get a handle on what healthcare reform means for CHI’s constituents, its members made up of leading biotechnology, medical device, diagnostics, and pharmaceutical companies, and public and private academic biomedical research organizations. Not just where healthcare reform is headed but what this means to innovators in California. On the one hand, healthcare reform is on the front page the New York Times everyday, but it also affects the day-to-day business of CHI’s members. This collection of leaders of industry is going to be able to give their views and my job as moderator will be to draw out those stories in an interactive setting.

Q: What do you feel participants will gain by attending the event?
A: Participants are going to get a cutting edge view of where we are in the debate from people with interesting perspectives on health policy and issues of innovation. On that first panel, we’ll be able to drive toward the “so what” for those in the innovation industry. Dr. David Gollaher, CHI’s president and CEO, will represent CHI members and what they are talking and thinking about. Dr. Alan Garber is a distinguished health policy expert, an economist and physician who specializes in the evaluation of medical technology. Dr. Sharon Levine is a physician at Kaiser, one of the senior leaders there responsible for thinking about public policy and the deployment of new technology so she’ll bring the perspective of what it’s like to be inside a large organization that makes decisions about the use of technology. And Michael Goldberg a leading venture capitalist, will talk about the effects of healthcare reform on the finance industry and ultimately, on the biomedical industry that relies so heavily on this type of investment. The panel will talk about such issues as the use of comparative effectiveness research, potential changes to reimbursement, the fact that more people will likely be covered at lower pricing and the resulting tremendous cost pressures moving forward. This panel will set up the conversations later in the day, which will feature CEOs from leading companies in the various sectors that make up the biomedical industry, giving them an opportunity to focus on what healthcare reform means to them and the various specifics they are concerned about.

Q: How do you see the provision of healthcare changing in the years to come? What part does innovation play in the new paradigm?
A: I’ve been an ongoing observer of the system for 30 years starting off by doing technology assessment. I think the environment going forward is going to challenge medical technology to deliver on the promise. It’s not just about “more is better” or “anything new is good.” That just won’t do in the future. Anything that is new in the future is going to have to demonstrate dramatically superior performance, meeting an unmet medical need where there really is nothing else available. One of the challenges I’ll pose to the group is why is it that in this industry, innovation means more expensive, where in every other industry, innovation means “better, faster, cheaper”? I think getting at the source of that is going to be an important contribution to this meeting.

Q: How must executives change their thinking in order to grow with the changing needs of the American consumer and/or the changing healthcare system?
A: I think executives need to gain clarity on what the goal is. The goal has been to find something novel that physicians can be persuaded to use. The hurdle is going to be much higher now. It’s going to be about delivering value in a much clearer way, relative to existing therapies in quality, outcomes and cost effectiveness.

Q: You mention in your writing the need for consumer education and the popularization of the concepts of how to improve the system in order to improve access and outcomes. How do you propose this to take place?
A: There’s a lot of misinformation. We are stuck in the notion that more is better and denial of anything is always bad. There is a real misunderstanding of how much healthcare costs and why. The basic problem is the average American household can’t afford the average cost of care. Everyone being subsidized by the richest 2 percent of Americans simply won’t work. So part of the collective education of consumers is the understanding that it’s expensive, costs are going up, the component elements of that are partly because of bad behavior on the part of the consumer, partly because of the high cost of care, partly because of the fragmented system providing care, and medical technology is one contributor to overall cost escalation. More judicious use of technology is a direction we’re likely to head in.

Q: What part of the California Healthcare Policy Forum are you most looking forward to?
A: With this event, we’re going to have an opportunity to interact with some decision makers on the public policy side at the state and federal level that are active in medical technology related issues. This is going to be a tremendous chance for people to learn about the “so what” about healthcare reform for people in the innovation industry and I think it will be a discussion not just cheerleading innovation but really drilling down on the challenges and encouraging them to think about how we can evolve to better meet the needs of the American public.

Register now for the California Healthcare Policy Forum.

CHI-Advancing California biomedical research and innovation