EPISODE 6: Ask The Expert with Randy Vogenberg, PhD: Navigating State-Level Legislation & The Future of Patient-Centered Care
- Whitney Vadeboncoeur
- Oct 16, 2024
- 9 min read
Updated: Mar 1
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Welcome to the sixth episode of Only Healthcare!
In this episode of the Only Healthcare Podcast, we sit down with Dr. Randy Vogenberg, PhD, to discuss the rising influence of state-level healthcare legislation and how employers must adapt to ensure their healthcare plans align with changing regulations. With over 270 pieces of healthcare legislation in 45 states, employers must understand how these changes may impact fully-funded and self-funded plans under ERISA.
Dr. Vogenberg also dives into the evolving landscape of patient-centered care, focusing on oncology as a key example. From managing multiple chronic conditions during cancer treatment to the growth of concierge services and integrated care models, oncology is setting the stage for how future specialties like cardiology and rheumatology will evolve.
Key Topics:
Why state-level healthcare legislation matters more than ever in 2024
The importance of understanding your healthcare plan coverage and data
How patient-centered oncology care is leading to better outcomes and lower costs
Emerging trends in biologics, cell therapy, and gene therapy for employers to watch
For feedback or to suggest topics for future episodes, reach out to us at onlyhealthcarepodcast@gmail.com.
About the Hosts:
Michael Navin brings 27+ years of experience in the pharmaceutical industry, specializing in commercialization. As the owner of a successful agency, he has launched numerous pharmaceutical products, making advanced treatments accessible to the public.
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This podcast and its content, including but not limited to audio recordings, images, and text, are the property of the Only Healthcare Podcast and are protected by international copyright laws. We appreciate all distribution and content sharing. Contact us at onlyhealthcarepodcast@gmail.com to access media kits, provide feedback, inquire about guest participation or to learn more. Thank you for listening!
Hosted by: Michael Navin & Randy Vogenberg, PhD
This Podcast is sponsored by:
Peek: Peek is reimagining access through innovation, technology, connectivity, and partnership. Peek offers a comprehensive and unique suite of solutions to help clients improve access and affordability for prescription drugs.
The Peek Meds Marketplace is one of Peek’s differentiated offerings that gives employers a revolutionary new approach to controlling runaway prescription costs for their employees by providing unprecedented transparency, simplicity - and cost savings. The Peek Meds Marketplace aggregates cash discount cards, manufacturer copay offset programs, and an employee’s insurance information to provide a holistic and personalized view of prescription price options. This easy-to-use platform offers a one-stop-shopping experience for prescription drugs.
Peek’s team has decades of experience in the pharmaceutical industry and offers various services to biopharma manufacturers, brokers, benefits consultants, third-party administrators and employers. Visit peekmeds.com to learn more.
Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.
Music by:Hanu Dixit, https://www.youtube.com/hanudixit
Episode 6 Transcript: Navigating State-Level Legislation & The Future of Patient-Centered Care with Randy Vogenberg, PhD
Randy Vogenberg, PhD (00:01)
Since we're in an election year in 2024, there really is not gonna be much happening at the federal level in terms of successful legislation other than just keeping the lights on in Congress for the country. So the real action is happening at the state level. And this is very important for planned sponsors who are employers to really pay attention to what's happening in your state or the states and what you're doing business. Right now, there's nearly 270 different pieces of legislation in 45 different states. And that is a tremendous increase over the last couple years. So it kind of shows that there's a lot of interest, the sustained momentum to do something about a variety of issues. And since nothing has happened at the federal level, they're to. for a long time.
So as a result of all this activity at the state level, it depends partly on whether you're a fully funded plan, you're purchasing insurance from a commercial insurance plan, or if you're a self -funded employer under the ERISA Act. So for those that are purchasing their plans, they're talking about their state, it's even more more important because you're gonna be directly affected by whatever legislation has passed in your state. You need to be involved, you need to be engaged, and you also need to better understand what's in or not in your plan as it relates to the benefits that you're trying to provide to your employees as a plan dealing with healthcare.
For those employers that are self-funded and under the ERISA legislation, you're looking at multi-state, and so you may be exempt from a lot of this legislation that's happening at the state level for now, but as the states pass legislation and they see the success and the implications that arise from this in terms of what's being offered at these plans that is different from before, it could be adopted at the federal level. So even though it may not directly affect you in 2025 or even 2026, there's a good chance that you're going to see federal legislation be developed and that will have an impact on what you can or can't do in your plan in future years. The concept of patient-centered care or some also call a medical home, also whole person care is also being thrown around today.
All these basically emanate from efforts years ago to try and have a better outcome with the patient and a better collaborative care experience of the patient with multiple providers of care. An oncology has been a great example for that over the years because why you're treating a specific cancer typically in a target organ or other conditions that that patient has, like high blood pressure, maybe diabetes, maybe some other neurological issue. And so all that has to be taken into account as they're going through their cancer care journey.
So the evolution of care pathways is somewhat related to that as well, not only for the specific cancer care, in a particular product or therapy, but also how do you manage these other conditions? If there is high blood pressure or diabetes or even an infection, how is this affecting the primary area of interest which would be cancer care. So what we're seeing today is a kind of resurgence in better collaborations between primary care or internal medicine with oncologists as a specialist as people are going through a cancer journey And this can provide better outcomes of care. It provides a better patient experience.
So the member of the health plan from an employer perspective could have not only better outcomes, but also better feeling around the care that they were able to get and hopefully the better outcomes that they achieved as a result of this more patient -centered care in combination of the primary care with the oncology care. There are also some companies that have been developed that provide a concierge type service in this coordination effort between primary care and oncology care. And we would expect to see the same happen in some of the other medical specialties like rheumatology, immunology, cardiology, where we're gonna see a lot of these other newer products that specialists will be prescribing and using in therapy while they still need the primary care involvement.
So from an employer perspective there's always been a concern about the escalating cost of care and are we getting better outcomes for this increased cost that we're paying. And what we've seen is a little bit of a divergence in terms of the types of therapies that we're paying for, but also we're also seeing kind of a mixed bag of outcomes that result from some of these therapies that are being utilized today. It's still early to tell where this is all going to lead, but clearly there's a need by employers to better understand their data, to better understand their plan, what's included and what's not included, or they, in essence, creating a problem for themselves by the way they've determined their coverage parameters.
So start thinking about what the data is telling you about the performance of your plan not just in economic terms but also in terms of the clinical care that's being paid for and delivered in your plan based on how you constructed your coverage. And so there's a database out of Indiana
That's been developed to other sources that have been around for a while as well that are focused around that Getting a handle on your data and the performance of your plan This is going to be increasingly important for employers as we see more higher -cost therapies coming onto the marketplace and In the next five years, there'll be Hundreds of these products and that will change the way in which care is being delivered, also where it's being delivered in some cases.
So it's not just the site of care, which we've been talking about for several years now, but also who is delivering that care? Is it being done in the home as opposed to in a hospital and so forth? So all these parameters should be data points that an employer should be paying attention to. So in the area of high cost biologics, cell and gene therapies in particular, we've seen a lot of new products and therapies enter onto the marketplace in the last few years. And in the cell therapy area, which are approved by the Food and Drug Administration, the FDA, they're really not drugs.
These are these are truly therapies and mostly involve what you're doing with a laboratory and treating blood. And so these cell therapies are a really interesting area and we've moved from the early first generation products to now a second generation and the third generation is now getting ready to come out of clinical trials. So for employers as plan sponsors you need to understand and appreciate these differences in terms of what this therapy is really all about how it works, where's it done, where's the patient who's receiving this care, what's the process of the care, how much time out of work they may have, or the caregiver may have to be out of work in order for their family member to have this therapy.
So there's all these different issues when we start looking at cell therapy, similar but different for gene therapy, more earlier stage, we're in the second generation now, but it tends to start out in the hospital, move into other areas over time, and we're still collecting data and understanding what's the performance of these gene therapies. For cell therapies, they're very well established, and what they're really doing is improving on a reduction of potential side effects, as well as producing better outcomes from these therapies. So it's a really interesting category. It's very expensive still, although the cost is starting to come down now, like most things do, but it's an area that employers really have to understand. So it's on time and appreciate what does it mean and how does it affect, again, your benefit coverage and what you're thinking about in terms of the performance of your plan and getting the appropriate data so that you can make decisions.
Overall, in thinking about this community oncology alliance meeting, looking at multiple stakeholders and oncology, what we're seeing is an acceleration and change overall. The things that we used to think about, talk about around oncology care, A lot of that is shifting not only because of the economics, but also because of the technology and the types of therapies that are now available for use in patient care. What that means for the plan sponsor, typically an employer, in the cases that we're talking about, there's a lot of opportunity to really have good coverage that is also very cost effective, and that is a change that we're beginning to see more realized in the real world. We're also seeing more pressures being applied around good oncology care, paying for good oncology care, through a whole variety of state legislative efforts.
So it's not happening at the federal level, it's happening at the state level. Eventually that will find its way to the federal level. So even if you're a RISA plan, you have to be paying attention to these trends. These trends not only are happening, there's a lot going on, but they're moving much faster than they have in the past. So this is a very active area and a aspect of your health plan that you as a plan sponsor, if you're an employer, really need to be paying attention to and thinking about what does that mean when we move into cardiology and other medical specialties beyond oncology because oncology is going to be kind of your canary in the coal mine opportunity to really start thinking differently about your plan and preparing for the future which is here today. You can get more information about what's going on in the health care industry, where we're at today, where we're headed into the future by listening to the only health care podcast.
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