TKG PACT Executive Briefings - 3-Minute Market Insights

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Welcome to the TKG PACT Executive Briefing, where in 3-minutes we highlight healthcare’s critical market access issues, policies, challenges, or trends. This resource offers condensed, 3-minute episodes of market insights.
Our passion is on achieving the Quintuple Aim of enhancing patient experience, improving population health, reducing costs, improving the work life of health care providers and staff., and enhancing health equity in all aspects of care delivery.
I’m Dr. Warren Smedley, thank you for joining us.

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Medication Adherence for Patients with Severe Mental Illness.

Medication Adherence for Patients with Severe Mental Illness.

Send us a textMedication Adherence for Patients with Severe Mental Illness.Adherence to prescribed medication regimens improves outcomes for patients with severe mental illness, such as schizophrenia, bipolar disorders, and major depressive disorder. Psychiatric disorders are a significant public health problem: schizophrenia affects about 23 million people worldwide, bipolar disorders affect about 60 million worldwide, and major depressive disorder affects another 350 million, people worldwide. Major depressive disorder is considered by many to be the most damaging psychiatric disorder and is associated with substantial disability, morbidity, mortality, and cost.Medication therapy is essential for the successful management of patients with serious mental illness. Medication non-adherence is highly prevalent, ranging between 63–74% in patients with schizophrenia1, about 50% in patients with bipolar disorders1, and as high as 60% in patients with major depressive disorder. About 25% of patients discontinue their medication within the first week after discharge from inpatient treatment. Further, the World Health Organization has reported that for persons with mental health issues and other, comorbid chronic diseases, medication nonadherence is 50%. Nonadherence is defined as taking less than 80% of prescribed doses, which has been validated in predicting future hospitalization rates.Need more information? As always, if you need a deeper dive into any of these topics, please don’t hesitate to reach out. Check out @The Kinetix Group‘s growing library of TKG PACT Executive Briefings where you can listen and download the companion PDF infographics.https://tkgpact.com/executive-briefings/

Episodes

Medication Adherence for Patients with Severe Mental Illness.

Medication Adherence for Patients with Severe Mental Illness.

Send us a textMedication Adherence for Patients with Severe Mental Illness.Adherence to prescribed medication regimens improves outcomes for patients with severe mental illness, such as schizophrenia, bipolar disorders, and major depressive disorder. Psychiatric disorders are a significant public health problem: schizophrenia affects about 23 million people worldwide, bipolar disorders affect about 60 million worldwide, and major depressive disorder affects another 350 million, people worldwide. Major depressive disorder is considered by many to be the most damaging psychiatric disorder and is associated with substantial disability, morbidity, mortality, and cost.Medication therapy is essential for the successful management of patients with serious mental illness. Medication non-adherence is highly prevalent, ranging between 63–74% in patients with schizophrenia1, about 50% in patients with bipolar disorders1, and as high as 60% in patients with major depressive disorder. About 25% of patients discontinue their medication within the first week after discharge from inpatient treatment. Further, the World Health Organization has reported that for persons with mental health issues and other, comorbid chronic diseases, medication nonadherence is 50%. Nonadherence is defined as taking less than 80% of prescribed doses, which has been validated in predicting future hospitalization rates.Need more information? As always, if you need a deeper dive into any of these topics, please don’t hesitate to reach out. Check out @The Kinetix Group‘s growing library of TKG PACT Executive Briefings where you can listen and download the companion PDF infographics.https://tkgpact.com/executive-briefings/

CRISPR Gene-Editing Therapy

CRISPR Gene-Editing Therapy

Send us a textIntroduction to Gene-Editing Therapy: CRISPRCRISPR is a relatively new medical advancement that was inspired by the natural defense mechanism found in some microbes, such as bacteria. To protect themselves against invaders like viruses, these microbes capture snippets of the intruder’s DNA and store them away as segments called CRISPRs, or Clustered Regularly Interspersed Short Palindromic Repeats. If the same germ tries to attack again, those DNA segments (turned into short pieces of RNA) help an enzyme called Cas find and slice up the invader’s DNA. In the laboratory, the CRISPR process consists of two main components: a DNA-cutting enzyme called “Cas9” modified with an added guide RNA. The guide RNA is engineered to mirror the target DNA of the gene to be edited. The guide RNA seeks for and locates, the target DNA. When the guide RNA finds an exact match, the Cas9 enzyme cuts, or modifies the target DNA. Need more information? As always, if you need a deeper dive into any of these topics, please don’t hesitate to reach out. Check out @The Kinetix Group‘s growing library of TKG PACT Executive Briefings where you can listen and download the companion PDF infographics.https://tkgpact.com/executive-briefings/

Introduction to Targeted Therapies: CAR T-cell Therapy

Introduction to Targeted Therapies: CAR T-cell Therapy

Send us a textIntroduction to Targeted Therapies: CAR T-cell Therapy T-cell Transfer Therapy is a special type of immunotherapy that takes a person’s own T-cells (a type of immune cell), adds specific antigens to the T-cells that can identify the cancer cells, and puts them back into the person’s body. Cancer cells express unique antigens (signaling proteins). T-cells are programmed in the lab to find those signals and deliver a cancer stopping treatment right to the individual cancer cell. There are two main types of T-cell transfer therapy: tumor-infiltrating lymphocytes (TIL) and CAR T-cell Therapy. Targeted therapies are evolving rapidly and are increasingly more patient specific, as well as significantly more complex to manufacture and deliver. With any of these therapies, life science companies may need to thoughtfully consider strategies for addressing market access needs, patient journey issues, and the complexities of clinical care delivery protocols. Need more information? Please email us at Insights@thekinetixgroup.comCheck out @The Kinetix Group‘s growing library of TKG PACT Executive Briefings where you can listen and download the companion PDF infographics.https://tkgpact.com/executive-briefings/

Provider Insights on the Impact of 340B Pricing

Provider Insights on the Impact of 340B Pricing

Send us a textProvider Insights on the Impact of 340B Pricing.We frequently get asked for insights on how the 340B Drug Pricing Program may... or may not... be impacting the prescribing choices of participating covered entities. The Health Resources and Services Administration (HRSA) administers this federal program which is intended to help safety-net providers carry out their missions to serve their communities. The Kinetix Group (TKG) recently conducted a market access research study to gain insights from healthcare providers on how the 340B program is impacting care delivery in covered entities. You can reach out to us for the full study, but a few of the highlights from our study are included in this briefingYou can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

The Federal NOPAIN Act

The Federal NOPAIN Act

Send us a textToday’s topic is the The Federal NOPAIN Act.The Federal “Non-Opioids Prevent Addiction In the Nation Act” (or, the “NOPAIN Act”), Senate bill S.586, was signed into law in December 2022. It takes effect this coming January as part of the Centers for Medicare and Medicaid Services 2025 OPPS proposed rule. The NOPAIN Act directs CMS to reimburse hospital and surgical centers separately for non-opioid, post-surgical pain control, in hopes of reducing or replacing opioid consumption. By separating, or “unbundling,” payment for non-opioid pain control, hospitals and surgical centers may receive additional reimbursement for non-opioid alternatives, encouraging the use of substitute means of pain control. This helps to ensure that non-opioid options are more widely available to individuals as a post-surgical treatment option.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

High Value Pharmacy Enterprise Framework

High Value Pharmacy Enterprise Framework

Send us a textThe High-Value Pharmacy Enterprise Framework.The High-Value Pharmacy Enterprise Framework is a collection of evidence-based and expert recommended best practices designed to enhance health system pharmacy operations by ensuring safe, effective, and patient-centered medication management throughout the health-system pharmacy enterprise. It is gaining in popularity due to the many patient safety, operational, and cost efficiencies it brings to health systems that embrace the model. The HVPE framework is built around 8 Domains of essential pharmacy practice elements that are established best practices for health-system pharmacies. The framework contains a total of 94 operational statements and 336 performance measures within these 8 domains.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Introduction to Targeted Therapies: Monoclonal Antibodies

Introduction to Targeted Therapies: Monoclonal Antibodies

Send us a textIntroduction to Targeted Therapies: Monoclonal AntibodiesTargeted Therapy is the foundation of Precision Medicine. Targeted therapy is a type of personalized treatment that targets specific proteins that control how cells grow, divide, and spread. Antibodies are produced naturally by our body and help the immune system recognize cells that cause disease, such as bacteria and viruses, and mark them for destruction. Antibodies can be engineered in the laboratory to find and attach themselves to specific targets, called antigens, found on cancer cells. They are made to recognize and bind only to a very specific antigen target. This week's episode highlights three important terms you may be hearing: Antibody-Drug Conjugates, Monoclonal Antibodies, and Bispecific Antibodies.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Pharmacist Collaborative Practice Agreements (CPAs)

Pharmacist Collaborative Practice Agreements (CPAs)

Send us a textAll 50 states now allow pharmacists and physicians to enter into Collaborative Practice Agreements (CPAs) in which one or more pharmacists establish a formal relationship with a prescriber, in which the prescriber can delegate specific tasks to a pharmacist under negotiated conditions, which would not otherwise be permitted under the pharmacist’s normal scope of practiceAlthough state laws vary, generally, CPAs allow prescribers to delegate specific patient care tasks to pharmacists. The pharmacist’s scope of practice under a CPA is generally defined by established protocols that are condition or disease specific. For example, under a CPA, pharmacists many be empowered to perform patient assessments, order laboratory tests, prescribe drugs, counsel patients, and make referrals for related care. They may also be permitted to select, initiate, monitor, continue, discontinue, adjust, and refill therapy regimens.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Understanding the “bagging” of Patient Medications

Understanding the “bagging” of Patient Medications

Send us a textWhen a physician prescribes an expensive specialty medication for a patient, the traditional distribution process was for the provider to purchase the medication, administer it to the patient, and then bill the insurance company for the drug. This “buy-and-bill” process has been utilized for many years. In recent years, and to help control costs, third-party payers have mandated that the medications come from their own pharmacies where they have more control over the acquisition price of the drugs. This is especially prevalent for expensive, specialty pharmaceuticals. Various alternatives of this approach have been referred to as “bagging”. In this episode, we define the different types of "bagging" that you may be hearing about.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Laboratory Benefit Managers

Laboratory Benefit Managers

Send us a textLaboratory Benefit Managers have emerged over the past decade to fill the need to manage complex and expensive laboratory testing for payers. They have become the new Precision Medicine Gatekeepers. Results from over 14 billion diagnostic tests are estimated to influence 70% of today’s clinical decisions. It’s estimated that there is both overutilization of testing in approximately 20% of cases, and underutilization of testing in approximately 45% of cases. Laboratory Benefit Managers have improved Next Generation Sequencing test payment turnaround times, but also have increased denial rates. You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Barriers to New Therapy Adoption: Therapeutic Inertia

Barriers to New Therapy Adoption: Therapeutic Inertia

Send us a textThe term therapeutic inertia describes the failure of health care providers to initiate or intensify therapy when it is clearly indicated by established guidelines. The term has largely been applied to the management of blood pressure, blood sugar, and cholesterol, by primary care physicians who recognize the need for their patients to control these conditions but fail to act sufficiently to achieve the guideline recommended therapeutic targets. Despite clearly articulated, evidence-based, clinical guidelines, some physicians fail to translate this knowledge into practice. We believe that therapeutic inertia plays a significant role in delaying the adoption of many new treatments. Most practitioners function within a “personal comfort zone” of prescribing behavior, being reluctant to take unnecessary risks with new drugs. There is a natural “learning curve,” where clinicians need to learn the side effect profiles and characteristics of new drugs, as well as to be assured that the drugs perform as promised.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

State Drug Price Transparency Laws

State Drug Price Transparency Laws

Send us a textSince 2016, 13 states have passed Drug Price Transparency Laws focused on enabling state policymakers to understand opaque drug pricing and payment systems to formulate policy solutions to high prices, while also creating the data infrastructure to realize those policy solutions. Most of these state programs require reporting from manufacturers when they increase the Wholesale Acquisition Cost (WAC) of a drug above a certain threshold or if they introduce a drug with a high launch price. Since 2020, 8 states have enacted Prescription Drug Affordability Boards often referred to as P-DABs, entities with the authority to review high cost drugs and in some states set an upper payment limit to ensure no one pays more than that amount in the state. You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

CMS Prior Authorization Final Rule

CMS Prior Authorization Final Rule

Send us a textToday's topic is the CMS Prior Authorization Final Rule On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.You can download the full Executive Briefing at: https://tkgpact.com/executive-briefings/Or, feel free to email us at Insights@thekinetixgroup.com

Federal No Surprises Act

Federal No Surprises Act

Send us a textToday’s topic is the Federal No Surprises Act.The Federal No Surprises Act is intended to protect consumers from unexpected medical bills that occur when a patient unknowingly receives medical services from physicians and other providers who are outside of their health insurance network; in other words, healthcare providers who are not “in network”. The law protects consumers specifically from surprise medical bills in three main scenarios:1. Emergency care from an Out-of-Network provider at an In-Network facility;2. Any care from an undisclosed Out-of-Network provider; and3. Uninsured or self-pay patients from unknown costs.You may download the full TKG PACT Executive Briefing highlighted in this episode, at Executive Briefings | TKG PACTWe welcome your suggestions, ideas, and requests for Executive Briefing topics of interest. Please email us at Insights@thekinetixgroup.com

Welcome to the New Format!

Welcome to the New Format!

Send us a textWelcome to our new and revised market insights podcast format, where we have renamed our program the TKG PACT Executive Briefing. The new format will be condensed into 3-minute episodes of market insights, where we highlight one of healthcare’s critical market access issues, policies, challenges, or trends.We hope you enjoy this new “3-Minute Market Insights” format and hope that this resource provides helpful information in smaller, easier to digest, sound bites. Most of these TKG PACT Executive Briefings will have a downloadable PDF that you can access on our website. Instructions will be given with each episode. Look for a new episode to be available about every other week.Need more information? Or have suggestions for topics of interest? Please email us at Insights@thekinetixgroup.com

Telehealth Policy Gaps: Challenges with Remote Prescribing

Telehealth Policy Gaps: Challenges with Remote Prescribing

Send us a textTelehealth Policy Gaps: Challenges with Remote PrescribingOn May 11th, the Public Health Emergency (PHE) and some of the provisions that supported the explosive growth of telehealth, will expire, leaving telehealth providers scrambling to address some of the challenges of proving remote care.My special guest in this episode is Dori Martini, Vice President of Operations and Regulatory Affairs for Circle Medical, a large, multi-state, contemporary, personalized primary care practice that offers high quality care, both in person, and via telemedicine. They are an affiliate of the University of California at San Francisco.Dori has an impressive understanding of the gaps – especially policy gaps - becoming evident in the day-to-day use of telehealth. In this episode, she shares some unique “best practices” in working around a few of the gaps and some practical ideas for managing your remote patients.

Circling the Wagons… to Solve Real Problems in Neurology

Circling the Wagons… to Solve Real Problems in Neurology

Send us a textCircling the Wagons… to Solve Real Problems in NeurologyIt is estimated that globally, one in six people are affected by a health issue that includes some form of a neurological disorder. Within the United States, as many as 100 million people are having some kind of an issue related to a neurological disorder. Add to that the explosion of breakthrough new therapies for challenging neurologic diseases and disorders, like Alzheimer's, Parkinson's, epilepsy, migraines, multiple sclerosis, stroke, and ALS. The field of neurology is growing rapidly and the demand for services from this specialty is way outpacing capacity. It’s an exciting, yet challenging, moment in the treatment of neurological disorders!Our special guests today are the Chief Executive Officer and Chief Operating Officer from DENT Neurologic Institute and NeuroNet Pro, Joe Fritz and Christine Mann. They are the leading experts in the business side of neurology, and we are going to dig into this unique specialty in today's episode.

"Period Poverty"... a Taboo Topic?

"Period Poverty"... a Taboo Topic?

Send us a text"Period Poverty"... a Taboo Topic?Unfortunately, there are some issues in healthcare that seem to get ignored, or simply don’t get discussed appropriately, and today’s topic is one of these challenging issues. In many circles, menstruation is a topic that is difficult to discuss openly, which complicates the challenges of period poverty. Today we explore the challenges of period poverty and how that may contribute to the significant global problem of Iron deficiency in reproductive age women.Our special guests today are Mindy Olivarez, Vice President of Innovation at The Kinetix Group, and Michela Bedard, the Executive Director at PERIOD, a nonprofit that aims to support individuals affected by challenging menstrual cycle issues.For mor information on PERIOD, visit their website at Peroid.org.

NCCN Policy & Advocacy Priorities

NCCN Policy & Advocacy Priorities

Send us a textNCCN Policy & Advocacy Priorities Supporting high quality cancer care through the NCCN Guidelines is a strategic pillar for the NCCN. Alyssa Schatz is the Senior Director of Policy & Advocacy at the National Comprehensive Cancer Network. She shares the current strategic priorities for her team in this week’s episode.

Musical Chairs... Improving Infusion Therapy.

Musical Chairs... Improving Infusion Therapy.

Send us a textMusical Chairs... Improving Infusion Therapy“Musical Chairs”… how are we managing infusion center operations amid the financial and staffing woes of a healthcare system exhausted from nearly 3 years of a roller coaster ride due to the pandemic? Our guests for this episode are Christine Mann, Chief Operating Officer and Director of the DENT Infusion Center, DENT Neurologic Institute, and Andre’ Diamant, Chief Executive Officer of Gray Oncology Solutions. Both are experts in infusion therapy operations.